How To Use HCPCS Code C9604

HCPCS code C9604 describes the percutaneous transluminal revascularization of or through a coronary artery bypass graft (internal mammary, free arterial, venous) using a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty. This code is specifically used for procedures involving a single vessel. In this article, we will explore the details of HCPCS code C9604, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS C9604?

HCPCS code C9604 is used to identify the percutaneous transluminal revascularization procedure performed on or through a coronary artery bypass graft. This procedure involves the use of a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty. It is important to note that this code is specifically used for procedures involving a single vessel.

2. Official Description

The official description of HCPCS code C9604 is “Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The procedure for HCPCS code C9604 involves percutaneous transluminal revascularization of or through a coronary artery bypass graft.
2. The provider will use a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty techniques.
3. Distal protection may be performed as part of the procedure.
4. This procedure is specifically performed on a single vessel.

4. When to use HCPCS code C9604

HCPCS code C9604 should be used when performing percutaneous transluminal revascularization on or through a coronary artery bypass graft. This code is applicable when a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty techniques are used, including distal protection if performed. It is important to note that this code is specifically used for procedures involving a single vessel.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9604, healthcare providers should ensure that the necessary documentation is in place to support the procedure performed. This may include operative reports, imaging studies, and any other relevant documentation. It is important to accurately code and document the specific details of the procedure, including the vessels involved, the techniques used, and any additional services provided.

6. Historical Information and Code Maintenance

HCPCS code C9604 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 is priced by other carriers, as indicated by the pricing indicator code 57. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

HCPCS code C9604 is subject to special coverage instructions, as indicated by the coverage code D. Medicare and other insurance providers may have specific guidelines and criteria for coverage of this procedure. It is important to review the individual payer’s policies and guidelines to determine coverage and reimbursement for HCPCS code C9604.

8. Examples

Here are five examples of when HCPCS code C9604 should be billed:

1. A patient with a single vessel coronary artery bypass graft undergoes percutaneous transluminal revascularization using a drug-eluting intracoronary stent, atherectomy, and angioplasty techniques.
2. A patient with a previous coronary artery bypass graft experiences restenosis in a single vessel and requires percutaneous transluminal revascularization using a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty.
3. A patient with a single vessel coronary artery bypass graft develops a significant blockage and undergoes percutaneous transluminal revascularization with distal protection using a drug-eluting intracoronary stent, atherectomy, and angioplasty techniques.
4. A patient with a single vessel coronary artery bypass graft experiences recurrent angina and requires percutaneous transluminal revascularization using a combination of drug-eluting intracoronary stent, atherectomy, and angioplasty.
5. A patient with a single vessel coronary artery bypass graft develops an occlusion and requires urgent percutaneous transluminal revascularization using a drug-eluting intracoronary stent, atherectomy, and angioplasty.