How To Use HCPCS Code C9475

HCPCS code C9475 describes the injection of necitumumab, with a dosage of 1 mg. This code is used to identify the administration of this specific medication in medical billing and coding. In this article, we will explore the details of HCPCS code C9475, 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 C9475?

HCPCS code C9475 is a specific code used to identify the injection of necitumumab, with a dosage of 1 mg. It is important to use this code accurately to ensure proper billing and reimbursement for the administration of this medication.

2. Official Description

The official description of HCPCS code C9475 is “Injection, necitumumab, 1 mg.” This description accurately represents the specific medication and dosage that this code refers to. The short description for this code is “Enteral supp not otherwise c,” which provides additional information about the nature of the service or supply.

3. Procedure

1. The procedure for administering necitumumab, as indicated by HCPCS code C9475, involves the following steps:

• Prepare the necessary equipment and supplies for the injection.
• Verify the patient’s identity and confirm the correct medication and dosage.
• Cleanse the injection site with an appropriate antiseptic solution.
• Administer the injection of necitumumab using the appropriate technique and route of administration.
• Monitor the patient for any adverse reactions or complications.
• Document the administration of the medication in the patient’s medical record.

4. When to use HCPCS code C9475

HCPCS code C9475 should be used when administering necitumumab, with a dosage of 1 mg. It is important to ensure that the medication and dosage match the description provided in the code. This code is typically used in cases where the patient requires this specific medication for their treatment plan.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of necitumumab using HCPCS code C9475, healthcare providers need to ensure that the following documentation requirements are met:

• Clearly document the administration of necitumumab, including the dosage and any relevant details.
• Include the patient’s medical record number and other identifying information.
• Submit the claim with the appropriate supporting documentation, such as the physician’s order for the medication.

6. Historical Information and Code Maintenance

HCPCS code C9475 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. This code has a pricing indicator code of 57, which indicates that it is priced by other carriers. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code C9475 may vary. It is important to check with the specific payer to determine if this code is payable. The Medicare Carriers Manual Reference Section Number for this code is 2130, which provides additional guidance on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9475 should be billed:

1. A patient with lung cancer receives an injection of necitumumab, 1 mg, as part of their chemotherapy treatment.
2. A physician administers necitumumab, 1 mg, to a patient with advanced squamous non-small cell lung cancer.
3. A hospital outpatient department provides an injection of necitumumab, 1 mg, to a patient with metastatic squamous non-small cell lung cancer.
4. A home healthcare agency administers necitumumab, 1 mg, to a patient with advanced lung cancer in their own residence.
5. A cancer treatment center administers necitumumab, 1 mg, to a patient as part of a clinical trial for lung cancer treatment.