How To Use HCPCS Code C9489

HCPCS code C9489 describes the injection of nusinersen, a medication used in the treatment of certain genetic disorders. This code is specifically used to identify the administration of 0.1 mg of nusinersen through injection. In this article, we will explore the details of HCPCS code C9489, 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 C9489?

HCPCS code C9489 is a specific code used to identify the injection of nusinersen, a medication used in the treatment of certain genetic disorders. This code is used to indicate the administration of 0.1 mg of nusinersen through injection. It is important for medical coders to accurately assign this code when reporting the administration of nusinersen to ensure proper reimbursement and tracking of this specific procedure.

2. Official Description

The official description of HCPCS code C9489 is “Injection, nusinersen, 0.1 mg”. This description clearly indicates that this code is used to identify the administration of nusinersen through injection, specifically in a dosage of 0.1 mg.

3. Procedure

1. Prepare the necessary equipment and supplies for the injection of nusinersen.
2. Verify the patient’s identity and confirm the correct dosage of 0.1 mg of nusinersen.
3. Select an appropriate injection site and prepare the area according to standard aseptic techniques.
4. Administer the injection of nusinersen using the appropriate technique and needle size.
5. Monitor the patient for any immediate adverse reactions or complications.
6. Document the administration of nusinersen, including the dosage, injection site, and any relevant patient information.

4. When to use HCPCS code C9489

HCPCS code C9489 should be used when reporting the administration of nusinersen in a dosage of 0.1 mg through injection. It is important to ensure that the specific dosage and route of administration match the details provided in the code description. This code should only be used for the administration of nusinersen and not for any other medications or procedures.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of nusinersen using HCPCS code C9489, healthcare providers should ensure that the necessary documentation is in place to support the claim. This may include documentation of the patient’s medical condition, the need for nusinersen treatment, and the specific dosage and route of administration. It is important to follow the billing guidelines provided by the relevant insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9489 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 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, indicating that 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 C9489 may vary depending on the specific policies and guidelines of each provider. It is important to check with the relevant insurance carriers to determine the coverage and reimbursement policies for the administration of nusinersen. The Medicare Carriers Manual Reference Section Number for this code is 2130, which provides additional information and guidance for Medicare billing.

8. Examples

Here are five examples of when HCPCS code C9489 should be billed:

1. A patient with a confirmed diagnosis of a genetic disorder requiring treatment with nusinersen receives an injection of 0.1 mg of the medication.
2. A healthcare provider administers nusinersen to a patient as part of a scheduled treatment plan, following the appropriate dosage and route of administration.
3. A patient with a documented medical condition that is responsive to nusinersen therapy receives an injection of the medication as prescribed by their healthcare provider.
4. A patient undergoing a clinical trial for nusinersen receives an injection of the medication as part of the trial protocol.
5. A patient with a genetic disorder requiring long-term nusinersen therapy receives regular injections of the medication, with each injection documented and billed using HCPCS code C9489.