How To Use HCPCS Code C9726

HCPCS code C9726 describes the placement and removal (if performed) of an applicator into the breast for intraoperative radiation therapy. This code is an add-on to the primary breast procedure. In this article, we will explore the details of HCPCS code C9726, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and examples.

1. What is HCPCS C9726?

HCPCS code C9726 is used to identify the placement and removal (if performed) of an applicator into the breast for intraoperative radiation therapy. It is an add-on code, which means it is reported in addition to the primary breast procedure. This code is specific to the procedure of placing and removing the applicator and does not include any other services or supplies.

2. Official Description

The official description of HCPCS code C9726 is “Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The provider begins the procedure by preparing the patient for intraoperative radiation therapy.
2. Anesthesia is administered to ensure the patient’s comfort during the procedure.
3. The provider then places the applicator into the breast, ensuring proper positioning for effective radiation therapy.
4. If necessary, the provider may also perform the removal of the applicator after the completion of the intraoperative radiation therapy.
5. The procedure is completed, and the patient is monitored for any post-procedure complications or discomfort.

4. When to use HCPCS code C9726

HCPCS code C9726 should be used when the provider performs the placement and/or removal of an applicator into the breast for intraoperative radiation therapy. It is important to note that this code is an add-on to the primary breast procedure, indicating that it should only be reported in conjunction with the primary procedure code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9726, healthcare providers should ensure that the documentation clearly supports the medical necessity of the procedure. The documentation should include details about the primary breast procedure, the need for intraoperative radiation therapy, and the placement and/or removal of the applicator. Additionally, providers should follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9726 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions to the code since its addition.

7. Medicare and Insurance Coverage

HCPCS code C9726 is subject to special coverage instructions, as indicated by the coverage code D. This means that specific guidelines or criteria may apply to the coverage of this code. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for further information on coverage and reimbursement. The pricing indicator code for HCPCS code C9726 is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code C9726 may be billed:

1. A patient undergoes a mastectomy for breast cancer and requires intraoperative radiation therapy. The provider places the applicator into the breast during the procedure, and HCPCS code C9726 is reported in addition to the primary breast procedure code.
2. A patient with a history of breast cancer recurrence undergoes a lumpectomy with intraoperative radiation therapy. The provider performs the placement and removal of the applicator, and HCPCS code C9726 is reported alongside the primary procedure code.
3. A patient undergoes a breast reconstruction surgery following a mastectomy. Intraoperative radiation therapy is deemed necessary, and the provider places the applicator into the breast during the procedure. HCPCS code C9726 is reported in addition to the primary breast reconstruction procedure code.
4. A patient with a breast tumor undergoes a partial mastectomy with intraoperative radiation therapy. The provider performs the placement and removal of the applicator, and HCPCS code C9726 is reported alongside the primary procedure code.
5. A patient undergoes a prophylactic mastectomy due to a high risk of breast cancer. Intraoperative radiation therapy is performed, and the provider places the applicator into the breast. HCPCS code C9726 is reported in addition to the primary prophylactic mastectomy procedure code.