Summary & Overview
HCPCS S9474: Enterostomal Therapy by Certified RN, Per Diem
HCPCS Level II code S9474 represents enterostomal therapy delivered by a registered nurse certified in enterostomal therapy, billed on a per diem basis. This code captures specialized nursing services for patients with stomas, complex wound or ostomy care needs, and related education and management. Nationally, accurate use of S9474 supports appropriate recognition of specialized nursing time and expertise across facility and home health settings, with implications for payer coverage and care coordination.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how the code is defined, common payer coverage considerations, and the clinical context in which enterostomal nursing is typically provided. The publication summarizes available benchmarking and policy-relevant points and highlights areas where documentation and coding specificity affect reimbursement and care delivery. Where input data is incomplete, the document notes "Data not available in the input." This summary is intended for national audiences including health plan analysts, revenue cycle professionals, and clinical managers seeking a clear reference for HCPCS Level II code S9474.
Billing Code Overview
HCPCS Level II code S9474 describes enterostomal therapy provided by a registered nurse certified in enterostomal therapy, billed per diem. The service type is specialized wound, ostomy, and continence nursing care delivered on a per diem basis. The typical site of service for this code is inpatient or outpatient facility settings and home health settings where per diem nursing services are provided, reflecting care focused on management of stomas, wound care related to ostomies, and related patient education and management.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a recent abdominoperineal resection for rectal cancer is discharged to home with a newly created end colostomy. The patient has comorbid diabetes mellitus and peripheral neuropathy that complicate pouch seal integrity and skin care. Enterostomal therapy by a registered nurse certified in enterostomal therapy (ET nurse) is provided on a per diem basis to manage stoma assessment, pouching system selection, peristomal skin evaluation, education for the patient and caregiver, and coordination of supplies and referrals.
The clinical workflow begins with a referral from the surgical team or home health intake nurse. The ET nurse performs an initial visit to document stoma type and location, measure stoma size, assess perfusion and peristomal skin, recommend a pouching system and accessories, and provide hands-on education for appliance changes. The nurse documents findings, communicates recommendations to the home health agency and durable medical equipment suppliers, and schedules follow-up per diem visits until the patient and caregiver demonstrate competency and the peristomal skin is stable. Visits may include ostomy site care, barrier application, skin adhesive testing, troubleshooting leakage, and collaboration with wound care or dietitian services as needed. Progress notes, procedure documentation, and supply orders are included in the medical record for billing with S9474 on a per diem basis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |