AHA Coding Clinic® for HCPCS - 2017 Issue 1; For Your Information
New diagnostic radiopharmaceuticals and new contrast agents
Appropriate reporting of new diagnostic radiopharmaceuticals and new contrast agents Hospitals may appropriately report HCPCS code C9399, Unclassified drugs or biologicals, for new drugs, biologicals and therapeutic radiopharmaceuticals, that are approved by the Food and Drug Administration (FDA) on or after January 1, 2004 for which pass-through status has not been approved and a HCPCS C code and APC payment has not been assigned. However, it would be inappropriate to report HCPCS code C9399 for new diagnostic radiopharmaceuticals and contrast agents prior to the approval of pass-through status. In this instance the new diagnostic radiopharmaceuticals and contrast agents...
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Article Overview
This article covers reporting guidance for hospitals on newly approved diagnostic radiopharmaceuticals and contrast agents, with emphasis on when unclassified or temporary HCPCS reporting options may be considered before pass-through status is granted. It is relevant to hospital outpatient coding, radiology, nuclear medicine, and compliance teams that monitor FDA-approved products and HCPCS assignment status. The discussion focuses on broad reporting categories, the role of HCPCS A, C, and J codes, and the relationship between FDA approval and APC payment assignment.
Why This Topic Matters
Accurate temporary reporting of new diagnostic imaging agents affects claims processing, payment, and compliance while formal HCPCS assignment is pending.
Article Sections
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Appropriate reporting of new diagnostic radiopharmaceuticals and new contrast agents
Overview of reporting considerations for newly approved diagnostic radiopharmaceuticals and contrast agents in the hospital setting. The section frames the article’s focus on HCPCS reporting categories and temporary coding pathways.
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New diagnostic radiopharmaceuticals
Discussion of reporting options for newly available diagnostic radiopharmaceutical products. The section addresses broad code categories used before permanent HCPCS assignment is available.
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New contrast agents
Discussion of reporting options for newly available contrast agents. The section focuses on temporary HCPCS reporting categories used before pass-through status and a permanent C code are assigned.
What You Will Learn
- How the article frames reporting for newly approved diagnostic imaging products
- Which HCPCS reporting categories are discussed for temporary use
- How the article distinguishes diagnostic radiopharmaceuticals from contrast agents
- What organizations and approval concepts are referenced in the guidance
Who Should Read This
- Hospital coders
- Outpatient reimbursement staff
- Radiology billing teams
- Nuclear medicine departments
- Compliance teams
Codes Discussed
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