How To Use HCPCS Code C1726

HCPCS code C1726 describes a catheter used for balloon dilatation in non-vascular procedures. This code is specifically used for enteral support that is not otherwise classified. In this article, we will explore the details of HCPCS code C1726, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C1726?

HCPCS code C1726 is used to identify a specific type of catheter known as a balloon dilatation catheter. This catheter is used in non-vascular procedures and is specifically designed for enteral support. It is important to note that this code is only applicable for enteral support that is not otherwise classified.

2. Official Description

The official description of HCPCS code C1726 is “Catheter, balloon dilatation, non-vascular.” The short description for this code is “Enteral supp not otherwise c.” This description accurately reflects the purpose and use of this specific catheter.

3. Procedure

1. The provider begins the procedure by selecting the appropriate size and type of balloon dilatation catheter based on the patient’s needs.
2. The provider then prepares the patient for the procedure, ensuring that the necessary preparations, such as fasting or bowel cleansing, have been completed.
3. The provider inserts the catheter into the appropriate enteral access point, such as the mouth or nose, and advances it to the desired location within the gastrointestinal tract.
4. Once the catheter is in place, the provider inflates the balloon portion of the catheter to dilate the targeted area, allowing for improved enteral support.
5. After the desired dilation is achieved, the provider deflates the balloon and removes the catheter from the patient.
6. The provider ensures that the patient is stable and monitors for any potential complications following the procedure.

4. When to use HCPCS code C1726

HCPCS code C1726 should be used when performing enteral support procedures that require the use of a balloon dilatation catheter. It is important to ensure that the procedure meets the specific criteria outlined in the code description, such as being non-vascular in nature and not otherwise classified under a different code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C1726, healthcare providers must ensure that the necessary documentation is completed accurately and thoroughly. This documentation should include details about the procedure performed, the medical necessity of the catheter, and any relevant patient information. Additionally, providers should follow the specific billing guidelines set forth by the payer, ensuring that all required information is included on the claim form.

6. Historical Information and Code Maintenance

HCPCS code C1726 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code C1726 is covered by Medicare and other insurance carriers. The pricing indicator code 57 indicates that this code is priced by carriers using methods other than the Medicare fee schedule. The multiple pricing indicator code A indicates that this code is not applicable for pricing under multiple methodologies. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidance on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C1726 should be billed:

1. A patient with a gastrointestinal obstruction requires balloon dilatation to restore proper enteral support.
2. A patient with a strictured esophagus undergoes balloon dilatation to improve enteral intake.
3. A patient with a narrowed pyloric sphincter requires balloon dilatation to facilitate enteral feeding.
4. A patient with a stenosed intestinal segment undergoes balloon dilatation to enhance enteral absorption.
5. A patient with a narrowed enteral access point requires balloon dilatation to ensure proper enteral support delivery.