How To Use HCPCS Code C9491

HCPCS code C9491 describes the injection of avelumab, with a dosage of 10 mg. This code is used to identify the administration of a specific medication and is important for medical coders to accurately document and bill for this service.

1. What is HCPCS C9491?

HCPCS code C9491 is a specific code used to identify the injection of avelumab, a medication with a dosage of 10 mg. This code is essential for medical coders to accurately document and bill for this particular service.

2. Official Description

The official description of HCPCS code C9491 is “Injection, avelumab, 10 mg”. The short description for this code is “Enteral supp not otherwise c”. It is important to use the exact descriptions provided when using this code for documentation and billing purposes.

3. Procedure

1. Prepare the medication: Ensure that the avelumab medication is properly stored and prepared according to the manufacturer’s instructions.
2. Verify patient information: Confirm the patient’s identity and ensure that the correct medication and dosage are being administered.
3. Administer the injection: Use a sterile technique to administer the avelumab injection to the patient. Follow proper injection protocols and guidelines.
4. Monitor the patient: After the injection, closely monitor the patient for any adverse reactions or side effects. Provide appropriate care and support as needed.
5. Document the procedure: Accurately document the administration of avelumab, including the dosage and any relevant patient information, in the patient’s medical record.

4. When to use HCPCS code C9491

HCPCS code C9491 should be used when administering the medication avelumab with a dosage of 10 mg. It is important to ensure that the specific medication and dosage match the description provided in the code. This code should only be used for the designated purpose and not for any other medications or dosages.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9491, healthcare providers should ensure that the documentation supports the administration of avelumab with a dosage of 10 mg. This includes documenting the patient’s information, the dosage administered, and any relevant details about the procedure. It is important to follow the billing guidelines set forth by the payer and provide any additional documentation required for reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9491 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has a termination date of December 31, 2017. This code has not undergone any maintenance actions, as indicated by the action code N, which means no maintenance for this code. It is important to note the historical context and termination date of the code when using it for documentation and billing purposes.

7. Medicare and Insurance Coverage

HCPCS code C9491 falls under the coverage code D, which indicates that special coverage instructions apply. The pricing indicator code for this code is 57, which means it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important to check with Medicare and other insurance providers to determine the coverage and reimbursement policies for this specific code.

8. Examples

Here are five examples of when HCPCS code C9491 should be billed:

1. A patient with a diagnosis of advanced melanoma receives an avelumab injection with a dosage of 10 mg as part of their treatment plan.
2. A healthcare provider administers avelumab to a patient with metastatic urothelial carcinoma, following the recommended dosage of 10 mg.
3. An oncology clinic administers avelumab to a patient with locally advanced or metastatic solid tumors, using the specified dosage of 10 mg.
4. A patient with Merkel cell carcinoma receives an avelumab injection with a dosage of 10 mg during their chemotherapy treatment.
5. A healthcare provider administers avelumab to a patient with metastatic renal cell carcinoma, following the recommended dosage of 10 mg.