How To Use HCPCS Code C9497

HCPCS code C9497 describes the inhalation powder form of Loxapine, with a strength of 10 mg. This code is used to identify and bill for the administration of this specific medication. In this article, we will explore the details of HCPCS code C9497, 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 C9497?

HCPCS code C9497 is a specific code used to identify and bill for the administration of Loxapine inhalation powder, with a strength of 10 mg. It is important to use this code accurately to ensure proper reimbursement and documentation.

2. Official Description

The official description of HCPCS code C9497 is “Loxapine, inhalation powder, 10 mg”. The short description for this code is “Enteral supp not otherwise c”. This description accurately represents the medication and its form.

3. Procedure

1. Prepare the inhalation device according to the manufacturer’s instructions.
2. Ensure the patient understands the proper technique for using the inhaler.
3. Instruct the patient to exhale fully and then place the mouthpiece of the inhaler in their mouth, forming a tight seal.
4. Administer the prescribed dose of Loxapine inhalation powder by activating the inhaler.
5. Instruct the patient to hold their breath for a few seconds and then exhale slowly.
6. Advise the patient to rinse their mouth with water after each use to minimize the risk of oral candidiasis.
7. Document the administration of Loxapine inhalation powder in the patient’s medical record.

4. When to use HCPCS code C9497

HCPCS code C9497 should be used when administering Loxapine inhalation powder, with a strength of 10 mg, to a patient. It is important to ensure that the patient meets the specific eligibility criteria for this medication and that it is medically necessary for their condition.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9497, healthcare providers should ensure that the following documentation is included:

• Documentation of the patient’s medical condition and the need for Loxapine inhalation powder.
• Date and time of administration.
• Dosage administered.
• Any relevant patient instructions or counseling provided.

Providers should also follow the billing guidelines set forth by the payer, ensuring that all necessary information is included on the claim form.

6. Historical Information and Code Maintenance

HCPCS code C9497 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 been terminated as of December 31, 2018. The termination of this code means that it is no longer valid for billing purposes.

7. Medicare and Insurance Coverage

HCPCS code C9497 is assigned 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. Medicare and other insurance coverage for HCPCS code C9497 may vary, and it is important to check with the specific payer for their coverage policies and reimbursement rates.

8. Examples

Here are five examples of when HCPCS code C9497 should be billed:

1. A patient with a diagnosis of schizophrenia is prescribed Loxapine inhalation powder for the management of their symptoms. The provider administers the medication in the office setting.
2. A patient with a history of bipolar disorder is experiencing an acute manic episode. Loxapine inhalation powder is administered in the emergency department to help manage their symptoms.
3. A patient with treatment-resistant depression is enrolled in a clinical trial for a new medication. As part of the trial protocol, they receive Loxapine inhalation powder under the supervision of the research team.
4. A patient with a diagnosis of schizoaffective disorder is admitted to an inpatient psychiatric unit. Loxapine inhalation powder is included in their medication regimen during their stay.
5. A patient with a diagnosis of delusional disorder is receiving outpatient treatment. Loxapine inhalation powder is prescribed as part of their ongoing medication management plan.