How To Use HCPCS Code C9606

HCPCS code C9606 describes the percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, in a single vessel.

1. What is HCPCS C9606?

HCPCS code C9606 is a specific code used to identify the percutaneous transluminal revascularization procedure performed during an acute myocardial infarction. This procedure involves the use of various techniques, such as drug-eluting intracoronary stent placement, atherectomy, and angioplasty, to restore blood flow in a single vessel affected by a total or subtotal occlusion. It also includes the performance of aspiration thrombectomy, if necessary.

2. Official Description

The official description of HCPCS code C9606 is “Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The procedure begins with the identification of an acute total or subtotal occlusion in a coronary artery or coronary artery bypass graft during an acute myocardial infarction.
2. The healthcare provider then determines the appropriate combination of interventions required to restore blood flow in the affected vessel. This may involve the use of drug-eluting intracoronary stents, atherectomy, and angioplasty.
3. If there is a presence of thrombus, aspiration thrombectomy may be performed to remove the clot.
4. The provider performs the percutaneous transluminal revascularization procedure using the selected techniques, ensuring the restoration of blood flow in the single vessel.

4. When to use HCPCS code C9606

HCPCS code C9606 should be used when a healthcare provider performs percutaneous transluminal revascularization during an acute myocardial infarction. This code is specifically applicable for cases involving a single vessel with a total or subtotal occlusion. It is important to ensure that the procedure meets the criteria outlined in the code description to accurately report and bill for the service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9606, healthcare providers need to ensure proper documentation of the procedure performed. This includes detailed information on the specific interventions used, such as drug-eluting intracoronary stents, atherectomy, angioplasty, and aspiration thrombectomy. The medical record should also include documentation of the acute myocardial infarction, the presence of a total or subtotal occlusion, and the affected single vessel.

6. Historical Information and Code Maintenance

HCPCS code C9606 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. The code is still currently active and can be used for reporting the described procedure.

7. Medicare and Insurance Coverage

HCPCS code C9606 is covered by Medicare and other insurance carriers. 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 it is not applicable as HCPCS priced under one methodology. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidance on billing and reimbursement for this code.

8. Examples

Here are five examples of scenarios where HCPCS code C9606 would be appropriate:

1. A patient presents with an acute myocardial infarction and is found to have a total occlusion in a single coronary artery. The healthcare provider performs percutaneous transluminal revascularization using drug-eluting intracoronary stents and angioplasty.
2. A patient who has previously undergone coronary artery bypass graft surgery experiences an acute myocardial infarction. During the procedure, a subtotal occlusion is identified in one of the bypass grafts. The provider performs percutaneous transluminal revascularization using a combination of atherectomy and aspiration thrombectomy.
3. A patient with a history of coronary artery disease presents with an acute myocardial infarction. The provider identifies a total occlusion in a single coronary artery and performs percutaneous transluminal revascularization using drug-eluting intracoronary stents, angioplasty, and aspiration thrombectomy.
4. A patient who has previously undergone coronary artery bypass graft surgery experiences an acute myocardial infarction. During the procedure, a subtotal occlusion is identified in one of the native coronary arteries. The provider performs percutaneous transluminal revascularization using a combination of drug-eluting intracoronary stents, atherectomy, and angioplasty.
5. A patient presents with an acute myocardial infarction and is found to have a total occlusion in a single coronary artery. The provider performs percutaneous transluminal revascularization using drug-eluting intracoronary stents, angioplasty, and aspiration thrombectomy.