How To Use HCPCS Code C9478

HCPCS code C9478 describes the injection of sebelipase alfa, with a dosage of 1 mg. This code is used to identify the administration of this specific medication and is typically used in medical coding and billing processes. In this article, we will explore the details of HCPCS code C9478, 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 C9478?

HCPCS code C9478 is a specific code used to identify the injection of sebelipase alfa, with a dosage of 1 mg. This code is part of the Healthcare Common Procedure Coding System (HCPCS) and is used by medical coders and billers to accurately document and bill for this particular procedure.

2. Official Description

The official description of HCPCS code C9478 is “Injection, sebelipase alfa, 1 mg.” This description provides a clear and concise explanation of the procedure being coded.

3. Procedure

1. Prepare the necessary equipment and medication for the injection.
2. Verify the patient’s identity and confirm the correct medication and dosage.
3. Cleanse the injection site with an appropriate antiseptic solution.
4. Administer the sebelipase alfa injection using the appropriate technique and needle size.
5. Monitor the patient for any adverse reactions or complications.
6. Document the procedure in the patient’s medical record.

4. When to use HCPCS code C9478

HCPCS code C9478 should be used when the healthcare provider administers an injection of sebelipase alfa, with a dosage of 1 mg. It is important to ensure that the procedure meets the specific criteria outlined in the code description to accurately use this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9478, healthcare providers should ensure that the following documentation is included:

• Documentation of the patient’s medical necessity for the procedure.
• Documentation of the specific dosage and administration details.
• Any supporting documentation, such as medical records or test results, that justify the use of this code.

6. Historical Information and Code Maintenance

HCPCS code C9478 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. The termination of a code means that it is no longer valid for use in medical coding and billing processes.

7. Medicare and Insurance Coverage

HCPCS code C9478 may have specific coverage instructions that apply, as indicated by the coverage code D. It is important to consult the Medicare Carriers Manual or other relevant references to determine the specific coverage guidelines for this code. The pricing indicator code for HCPCS code C9478 is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code C9478 should be billed:

1. A patient with a diagnosed lysosomal acid lipase deficiency receives an injection of sebelipase alfa, with a dosage of 1 mg.
2. A healthcare provider administers sebelipase alfa to a patient as part of a clinical trial.
3. A patient with a confirmed diagnosis of Wolman disease receives an injection of sebelipase alfa, with a dosage of 1 mg.
4. A healthcare provider administers sebelipase alfa to a patient with a documented medical necessity for this specific medication.
5. A patient with a history of lipid metabolism disorders receives an injection of sebelipase alfa, with a dosage of 1 mg.