How To Use HCPCS Code C9474

HCPCS code C9474 describes the injection of irinotecan liposome, with a dosage of 1 mg. This code is used to identify the specific procedure of administering irinotecan liposome through injection. In this article, we will explore the details of HCPCS code C9474, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS C9474?

HCPCS code C9474 is a specific code used to identify the injection of irinotecan liposome, with a dosage of 1 mg. It is important for medical coders to accurately assign this code when reporting the administration of irinotecan liposome through injection.

2. Official Description

The official description of HCPCS code C9474 is “Injection, irinotecan liposome, 1 mg.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. Prepare the irinotecan liposome injection according to the manufacturer’s instructions.
2. Verify the patient’s identity and confirm the correct dosage of 1 mg.
3. Select an appropriate injection site, ensuring proper aseptic technique.
4. Administer the irinotecan liposome injection using the appropriate needle and syringe.
5. Monitor the patient for any adverse reactions or complications.

4. When to use HCPCS code C9474

HCPCS code C9474 should be used when reporting the administration of irinotecan liposome through injection. It is important to ensure that the dosage administered matches the 1 mg specified in the code description. This code should only be used for the specific procedure described and not for any other parenteral support.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of irinotecan liposome using HCPCS code C9474, healthcare providers should ensure that the following documentation is included:

• Medical record indicating the need for the irinotecan liposome injection
• Date and time of the procedure
• Dosage administered (1 mg)
• Any relevant patient information or medical history

Providers should also follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9474 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. This code was terminated on December 31, 2016, and is no longer in use. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code C9474 may have special coverage instructions that apply, as indicated by the coverage code D. It is important to review the specific coverage guidelines provided by Medicare or other insurance carriers to determine the reimbursement eligibility for this code.

The pricing indicator code for HCPCS code C9474 is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Providers should consult the Medicare Carriers Manual Reference Section Number 2130 for further guidance on pricing and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code C9474 should be billed:

1. A patient with advanced cancer receives an irinotecan liposome injection as part of their chemotherapy treatment.
2. A physician administers an irinotecan liposome injection to a patient with metastatic colorectal cancer.
3. A healthcare provider administers an irinotecan liposome injection to a patient participating in a clinical trial for a specific type of cancer.
4. A patient with recurrent ovarian cancer receives an irinotecan liposome injection as part of their treatment plan.
5. An oncology nurse administers an irinotecan liposome injection to a patient with pancreatic cancer.