How To Use HCPCS Code C1604

HCPCS code C1604 describes a graft, transmural transvenous arterial bypass (implantable), with all delivery system components. This code is used to identify a specific procedure that involves the placement of a graft to create a bypass between an artery and a vein. The graft is implanted transmurally, meaning it passes through the walls of both the artery and the vein. This procedure is typically performed to improve blood flow and circulation in patients with arterial blockages or other vascular conditions.

1. What is HCPCS C1604?

HCPCS code C1604 is a specific code that is used to identify the graft, transmural transvenous arterial bypass procedure. It is important to note that this code is only applicable when all delivery system components are included. The code is used to accurately document and bill for this specific procedure.

2. Official Description

The official description of HCPCS code C1604 is “Graft, transmural transvenous arterial bypass (implantable), with all delivery system components.” The short description for this code is “Parenteral supp not othrws c.” This description provides a clear and concise explanation of the procedure and the components involved.

3. Procedure

1. The graft, transmural transvenous arterial bypass procedure begins with the identification of the artery and vein that require bypass.
2. An incision is made in the skin to access the artery and vein.
3. The graft, which is a synthetic or biological conduit, is prepared for implantation.
4. The graft is carefully inserted through the walls of the artery and vein, creating a bypass between the two.
5. The graft is secured in place using sutures or other fixation methods.
6. The incision is closed, and the patient is monitored for any complications or adverse reactions.

This procedure requires the use of all delivery system components, which may include the graft itself, any necessary tools or instruments, and any other materials or supplies needed for the successful completion of the procedure.

4. When to use HCPCS code C1604

HCPCS code C1604 should be used when performing a graft, transmural transvenous arterial bypass procedure with all delivery system components. This code is specific to this particular procedure and should not be used for any other similar or related procedures. It is important to accurately document and code the procedure to ensure proper billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for the graft, transmural transvenous arterial bypass procedure using HCPCS code C1604, healthcare providers should ensure that all necessary documentation is included. This may include the patient’s medical history, the reason for the procedure, any pre-operative evaluations or tests, the details of the procedure itself, and any post-operative care or follow-up instructions. It is important to accurately document the use of all delivery system components to support the use of this specific code.

6. Historical Information and Code Maintenance

HCPCS code C1604 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use for several years and has not undergone any significant changes or updates since its addition.

7. Medicare and Insurance Coverage

HCPCS code C1604 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means that it is not applicable as HCPCS priced under one methodology. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions on billing and reimbursement for this procedure.

8. Examples

Here are five examples of when HCPCS code C1604 should be billed:

1. A patient with severe arterial blockages undergoes a graft, transmural transvenous arterial bypass procedure to improve blood flow and circulation.
2. A patient with a vascular condition requires a bypass between an artery and a vein to restore proper blood flow.
3. A patient with a history of arterial disease undergoes a graft procedure to prevent further complications.
4. A patient with a blocked artery in the lower extremities undergoes a bypass procedure to restore blood flow and prevent amputation.
5. A patient with a congenital vascular anomaly requires a graft procedure to correct the abnormality and improve overall vascular health.