GE Healthcare FAQs
2009

Did the code descriptor for Myoview change?

Yes. The code descriptor for Myoview effective January 1, 2009, is A9502 Technetium tc99m tetrofosmin, diagnostic, per study dose.  CMS has removed the "up to 40 mCi" reference that had been added to the long descriptor in 2006.

Code and bill Myoview per study dose, at rest and at stress. Report the appropriate number of doses administered (1 or 2) on your claim.

How do we code and bill for AdreView?

In a hospital outpatient setting, when billing Medicare, use code C9247 Iobenguane, I-123, diagnostic per study dose, up to 10 millicuries. Medicare may request the National Drug Code (NDC) number. If so, report the NDC # 17156-0235-01 using the Revenue Description Field (form locator 43) on the UB-04.

Effective April 1, 2009, Medicare has granted pass-through status to C9247 in hospital outpatient departments.  It will be assigned status indicator "G".  For more information, please refer to Transmittal #R1702CP, issued March 13, 2009, which can be accessed at: http://www.cms.hhs.gov/Transmittals/2009Trans/list.asp?listpage=4

For all other payers and when billing Medicare-Part B (in a physician office or freestanding facility) use code A4641 Radiopharmaceutical, diagnostic, not otherwise classified.  Report the NDC number for AdreView, if required by the specific payer. When billing on the UB-04, follow the reporting instruction above. For reporting of the NDC number on the CMS-1500 claim form, submit the NDC number in the red shaded portion of the detail line item.

Payers often request National Drug Code (NDC) numbers.   However, when I include them on my claims, payment is still being denied?   Why?

National Drug Code numbers are assigned by the Food & Drug Administration (FDA). The FDA typically assigns NDC numbers that are 10-digits in length. However, for billing purposes on the CMS-1500 claim form and the UB-04 claim form, payers require 11-digits. The NDC number is divided into three parts: the first five digits identify the labeler code of the manufacturer; the next three digits identify the drug product; and the last two digits identify the packaging of the drug.

For example: The NDC number for AdreView, as assigned by the FDA is 17156-235-01 (10-digits). On your claim form, add a lead-in zero to the second group of numbers to identify the drug, 0235.

Myoview^TM (technetium Tc-99m tetrofosmin)

In studying patients with known or suspected coronary artery disease, care should be taken to ensure continuous cardiac monitoring and the availability of emergency cardiac treatment. As with all injectable drug products, allergic reactions, and anaphylaxis may occur. Pharmacologic induction of cardiovascular stress may be associated with serious adverse events, such as myocardial infarction, arrhythmia, hypotension, bronchoconstriction, and cerebrovascular events. Caution should be used when pharmacologic stress is selected as an alternative to exercise; it should be used when indicated and in accordance with the pharmacologic stress agent's labeling. The most common adverse reactions reported from post-marketing experience included rash, urticaria, abnormal vision, allergic reactions, and fever.

Prescribing Information

Adreview ^TM (Iobenguane I 123 Injection)

AdreView contains benzyl alcohol (10.3 mg/mL), which may cause serious reactions in premature or low birth-weight infants. Benzyl alcohol has been associated with a fatal "Gasping Syndrome" in premature infants and infants of low birth weight. Have anaphylactic and hypersensitivity treatment measures available prior to AdreView administration. AdreView is cleared by glomerular filtration and is not dialyzable. The radiation dose to patients with severe renal impairment may be increased due to the delayed elimination of the drug. AdreView is contraindicated in patients with known hypersensitivity to iobenguane or iobenguane sulfate. In clinical trials the most common adverse reactions seen were dizziness, rash, pruritis, flushing, or injection site hemorrhage reported in less than 1% of patients.

Prescribing Information