How To Use HCPCS Code C1772

HCPCS code C1772 describes an infusion pump that is programmable and implantable. This code is used to identify enteral supplies that are not otherwise classified. In this article, we will explore the details of HCPCS code C1772, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C1772?

HCPCS code C1772 is used to identify a programmable infusion pump that is implanted in the patient’s body. This pump is designed to deliver enteral supplies, such as nutrients or medications, directly into the patient’s digestive system. It is typically used for patients who are unable to consume food or medications orally and require a more controlled and precise delivery method.

2. Official Description

The official description of HCPCS code C1772 is “Infusion pump, programmable (implantable)”. The short description is “Enteral supp not otherwise c”. This description accurately represents the purpose and function of the code.

3. Procedure

1. The procedure for HCPCS code C1772 involves the surgical implantation of the programmable infusion pump into the patient’s body. This procedure is typically performed by a qualified healthcare professional, such as a surgeon or interventional radiologist.
2. During the procedure, the healthcare professional will make a small incision in the patient’s body, usually in the abdominal area, to create a pocket for the implantable pump.
3. The pump is then carefully placed into the pocket and secured in place.
4. Once the pump is implanted, the healthcare professional will program it to deliver the enteral supplies at the prescribed rate and schedule.
5. Regular follow-up visits may be required to monitor the functioning of the pump and make any necessary adjustments.

4. When to use HCPCS code C1772

HCPCS code C1772 should be used when billing for the implantation of a programmable infusion pump for enteral supplies. It is important to ensure that the patient meets the specific eligibility criteria for this procedure and that the use of the pump is medically necessary.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C1772, healthcare providers need to document the medical necessity of the procedure and provide supporting documentation, such as the patient’s medical history, diagnostic tests, and any other relevant information. It is also important to include the details of the procedure, including the date of implantation, the type of pump used, and any complications or additional services provided.

6. Historical Information and Code Maintenance

HCPCS code C1772 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 remained unchanged since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code C1772 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code 57 indicates that the payment for this code is determined by other carriers. The multiple pricing indicator code A indicates that the code 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 code.

8. Examples

Here are five examples of when HCPCS code C1772 should be billed:

1. A patient with a severe gastrointestinal disorder requires long-term enteral nutrition. The programmable infusion pump is implanted to ensure a controlled and continuous delivery of nutrients.
2. A patient with a chronic illness requires regular administration of enteral medications. The implantable pump is used to deliver the medications at the prescribed rate and schedule.
3. A patient undergoes surgery that affects their ability to consume food orally. The programmable infusion pump is implanted to provide enteral nutrition during the recovery period.
4. A patient with a digestive system disorder requires enteral feeding due to the inability to absorb nutrients orally. The implantable pump ensures a precise and consistent delivery of nutrients.
5. A patient with a progressive neurological condition requires enteral medications for symptom management. The programmable infusion pump is implanted to provide a continuous and controlled delivery of the medications.