How To Use HCPCS Code C9605

HCPCS code C9605 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 also includes the use of distal protection when performed. Additionally, each additional branch subtended by the bypass graft should be listed separately in addition to the code for the primary procedure.

1. What is HCPCS C9605?

HCPCS code C9605 is used to identify the specific procedure of percutaneous transluminal revascularization performed on or through a coronary artery bypass graft. This procedure involves the use of various techniques such as drug-eluting intracoronary stent placement, atherectomy, and angioplasty. It also includes the use of distal protection when necessary. The code C9605 is used to accurately report and bill for this specific procedure.

2. Official Description

The official description of HCPCS code C9605 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; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)”. The short description for this code is “Parenteral supp not othrws c”.

3. Procedure

1. The provider begins the procedure by accessing the coronary artery bypass graft.
2. A guidewire is then inserted into the graft, allowing for the passage of various interventional devices.
3. If necessary, a drug-eluting intracoronary stent is placed within the graft to help maintain its patency.
4. Atherectomy may be performed to remove any plaque or blockages within the graft.
5. Angioplasty is then performed to further open up the graft and improve blood flow.
6. If deemed necessary, distal protection devices may be used to prevent the dislodgement of any debris during the procedure.
7. If there are additional branches subtended by the bypass graft, they should be listed separately in addition to the primary procedure code.

4. When to use HCPCS code C9605

HCPCS code C9605 should be used when the provider performs percutaneous transluminal revascularization on or through a coronary artery bypass graft. This code is specifically for cases where drug-eluting intracoronary stents, atherectomy, and angioplasty are used in combination, along with the potential use of distal protection devices. It is important to list any additional branches subtended by the bypass graft separately in addition to the primary procedure code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9605, healthcare providers should ensure that the documentation accurately reflects the performance of percutaneous transluminal revascularization on or through a coronary artery bypass graft. The medical record should include details of the specific techniques used, such as drug-eluting intracoronary stent placement, atherectomy, angioplasty, and the use of distal protection devices if applicable. It is also important to clearly indicate any additional branches subtended by the bypass graft.

6. Historical Information and Code Maintenance

HCPCS code C9605 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 falls under the category of “Special coverage instructions apply” and is priced by other carriers.

7. Medicare and Insurance Coverage

HCPCS code C9605 is subject to special coverage instructions and may have specific guidelines for reimbursement by Medicare and other insurance carriers. The pricing indicator code 57 indicates that this code is priced by other carriers. The multiple pricing indicator code A means that it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for further guidance on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9605 should be billed:

1. A patient with a previous coronary artery bypass graft presents with significant blockages in the graft and requires percutaneous transluminal revascularization using drug-eluting intracoronary stents, atherectomy, and angioplasty.
2. A patient with multiple bypass grafts experiences restenosis in one of the grafts and undergoes percutaneous transluminal revascularization with the use of drug-eluting intracoronary stents, atherectomy, and angioplasty.
3. A patient with a bypass graft subtending multiple branches requires percutaneous transluminal revascularization on each branch, in addition to the primary procedure, using drug-eluting intracoronary stents, atherectomy, and angioplasty.
4. A patient with a bypass graft experiences a complication during the initial procedure and requires a repeat percutaneous transluminal revascularization with the use of drug-eluting intracoronary stents, atherectomy, and angioplasty.
5. A patient with a bypass graft and a significant blockage in a branch subtended by the graft undergoes percutaneous transluminal revascularization on the branch, in addition to the primary procedure, using drug-eluting intracoronary stents, atherectomy, and angioplasty.