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Miscellaneous Medical Surgical Supplies Billing Code Conversion – Corrected Codes

Updated September 3, 2009

The ICD-9-CM diagnosis codes previously listed for new HCPCS codes A4217 and A4649 have been corrected. Effective for dates of service on or after August 1, 2009, the table below shows the correct diagnosis codes. Modifiers and revenue codes are not affected

Providers should bill the new coding standards for dates of service on or after August 1, 2009.

Current Billing Codes New Billing Codes
Interim Code Description National Codes Billing Instructions
X1516 Natural (laminaria) hygroscopic sticks HCPCS Code:
A4649 – Surgical supply; miscellaneous
+
HCPCS Modifier:
U1 – Medicaid level of care 1, as defined by each state
+
ICD-9-CM Code:
632 – Missed abortion
634.00 – 634.92 – Spontaneous abortion


635.00 – 635.92 – Legally induced abortion
V61.7 – Legally induced abortion
+
Revenue Code (UB-04 only):
0272 – Medical/Surgical supplies and devices, sterile supply		 For providers billing on a CMS-1500: Use HCPCS code A4649 and modifier U1 to indicate the use of natural laminaria, maximum 12 units per day, in addition to ICD-9-CM diagnosis codes 632, 634 – 634.92, 635 – 635.92 or V61.7.

For facility claims (UB-04):
Use HCPCS code A4649 and modifier U1 to indicate the use
of natural laminaria, maximum
12 units per day, in addition to
ICD-9-CM diagnosis codes
632, 634 – 634.92, 635 – 635.92 or V61.7 and revenue
code 0272.
X1518 Synthetic hygroscopic sticks HCPCS Code:
A4649 – Surgical supply; miscellaneous
+
HCPCS Modifier:
U2 – Medicaid level of care 2, as defined by each state
+
ICD-9-CM Code:
ICD-9-CM Code:
632 – Missed abortion
634.00 – 634.92 – Spontaneous abortion


635.00 – 635.92 – Legally induced abortion
V61.7 – Legally induced abortion
+
Revenue Code (UB-04 only):
0272 – Medical/Surgical supplies and devices, sterile supply		 For providers billing on a CMS-1500: Use HCPCS code A4649 and modifier U2 to indicate the use of synthetic laminaria, maximum 4 units per day, in addition to ICD-9-CM diagnosis codes 632, 634 – 634.92, 635 – 635.92 or V61.7.

For facility claims (UB-04):
Use HCPCS code A4649 and modifier U2 to indicate the use
of synthetic laminaria, maximum
4 units per day, in addition to
ICD-9-CM diagnosis codes
632, 634 – 634.92, 635 – 635.92 or V61.7.and revenue
code 0272.
X7704 Administered irrigation solutions, each 1000 ml, including related supplies HCPCS Code:
A4217 – Sterile water/saline, 500 ml
+
Revenue Code (UB-04 only):
0270 – Medical/Surgical supplies and devices, general		 For providers billing on a CMS-1500:
Use HCPCS code A4217, per 500 ml, maximum 12 units per day.

For facility claims (UB-04):
Use HCPCS code A4217, per 500 ml, maximum 12 units per day, and revenue code 0270.

For more information, providers may call the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday.