How To Use HCPCS Code C1789

HCPCS code C1789 describes a breast prosthesis that is implantable. This code is used to identify the specific type of prosthesis used in breast reconstruction surgeries. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for these procedures.

1. What is HCPCS C1789?

HCPCS code C1789 is a specific code used to identify a breast prosthesis that is implantable. This code is used in medical coding to accurately document and bill for breast reconstruction surgeries. It is important to use this code when the specific prosthesis described in the code is used in the procedure.

2. Official Description

The official description of HCPCS code C1789 is “Prosthesis, breast (implantable)”. The short description for this code is “Parenteral supp not othrws c”. This description accurately identifies the type of prosthesis and its purpose in breast reconstruction surgeries.

3. Procedure

1. The breast prosthesis described in HCPCS code C1789 is surgically implanted during breast reconstruction surgeries.
2. The procedure involves creating a pocket in the chest wall where the prosthesis will be placed.
3. The prosthesis is then carefully inserted into the pocket and positioned to achieve the desired aesthetic outcome.
4. The incisions are closed, and the patient is monitored for any post-operative complications.

4. When to use HCPCS code C1789

HCPCS code C1789 should be used when a breast prosthesis that is implantable is used in a breast reconstruction surgery. This code is specific to the type of prosthesis and should not be used for other types of breast prostheses. It is important to review the medical documentation and confirm that the specific prosthesis described in the code was used in the procedure before assigning HCPCS code C1789.

5. Billing Guidelines and Documentation Requirements

When billing for breast reconstruction surgeries using HCPCS code C1789, healthcare providers should ensure that the medical documentation supports the use of the specific implantable breast prosthesis described in the code. This may include operative reports, implant specifications, and any other relevant documentation. It is important to accurately document the details of the procedure and the specific prosthesis used in order to support the billing of HCPCS code C1789.

6. Historical Information and Code Maintenance

HCPCS code C1789 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 HCPCS.

7. Medicare and Insurance Coverage

HCPCS code C1789 is covered 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 review the specific reimbursement policies of Medicare and other insurance providers to determine the coverage and payment guidelines for breast reconstruction surgeries using HCPCS code C1789.

8. Examples

Here are five examples of when HCPCS code C1789 should be billed:

1. A patient undergoes a mastectomy and subsequently undergoes breast reconstruction surgery using an implantable breast prosthesis described in HCPCS code C1789.
2. A patient with a history of breast cancer undergoes prophylactic mastectomy and chooses to have breast reconstruction surgery using an implantable breast prosthesis described in HCPCS code C1789.
3. A patient undergoes breast reconstruction surgery following trauma or injury to the breast and an implantable breast prosthesis described in HCPCS code C1789 is used.
4. A patient undergoes breast reconstruction surgery after previous failed breast augmentation and an implantable breast prosthesis described in HCPCS code C1789 is used.
5. A patient undergoes breast reconstruction surgery after previous breast reduction and an implantable breast prosthesis described in HCPCS code C1789 is used to achieve the desired aesthetic outcome.