How To Use HCPCS Code C9735

HCPCS code C9735 describes the procedure of anoscopy with directed submucosal injection(s) of any substance. This code is used to identify a specific medical procedure that involves the examination of the anus and rectum using a specialized instrument called an anoscope. During this procedure, a healthcare provider may also administer a submucosal injection of a substance for diagnostic or therapeutic purposes.

1. What is HCPCS C9735?

HCPCS code C9735 is a specific code used in medical coding to identify the procedure of anoscopy with directed submucosal injection(s) of any substance. Anoscopy is a diagnostic procedure that allows healthcare providers to visually examine the anus and rectum using an anoscope, a small, tubular instrument. The directed submucosal injection(s) refer to the administration of a substance into the submucosal layer of the anus or rectum during the anoscopy procedure.

2. Official Description

The official description of HCPCS code C9735 is “Anoscopy; with directed submucosal injection(s), any substance.” The short description for this code is “Enteral supp not otherwise c.” This description accurately reflects the nature of the procedure and the purpose of the code.

3. Procedure

1. The healthcare provider begins the procedure by preparing the patient and explaining the process.
2. Anesthesia may be administered to ensure the patient’s comfort during the procedure.
3. The anoscope, a specialized instrument, is inserted into the anus to provide a clear view of the rectal area.
4. If necessary, the healthcare provider may perform a directed submucosal injection(s) of a substance into the submucosal layer of the anus or rectum.
5. The provider carefully examines the anus and rectum for any abnormalities or signs of disease.
6. After the examination, the anoscope is gently removed, and the procedure is complete.

4. When to use HCPCS code C9735

HCPCS code C9735 should be used when a healthcare provider performs the specific procedure of anoscopy with directed submucosal injection(s) of any substance. This code is used to identify and bill for this particular procedure. It is important to ensure that the procedure meets the criteria outlined in the code description and is performed as documented.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9735, healthcare providers should ensure that the necessary documentation is in place to support the procedure. This may include the medical necessity for the procedure, the specific substance used for the directed submucosal injection(s), and any relevant clinical findings or indications for the procedure. It is important to follow the specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9735 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has a termination date of December 31, 2014, indicating that it is no longer an active code. The code has a pricing indicator code of 57, which signifies 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. The Medicare Carriers Manual Reference Section Number for this code is 2130.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code C9735 may vary depending on the specific circumstances and guidelines set forth by Medicare. It is important to consult the Medicare coverage policies and guidelines to determine the coverage and reimbursement for this procedure. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code C9735 may be billed:

1. A patient presents with rectal bleeding and undergoes an anoscopy with directed submucosal injection(s) to identify the source of bleeding.
2. A healthcare provider performs an anoscopy with directed submucosal injection(s) of a therapeutic substance to treat a rectal fistula.
3. A patient with a history of anal cancer undergoes regular surveillance anoscopy with directed submucosal injection(s) to monitor for recurrence.
4. A healthcare provider performs an anoscopy with directed submucosal injection(s) of a contrast agent to aid in the diagnosis of a rectal stricture.
5. A patient with chronic anal fissures undergoes an anoscopy with directed submucosal injection(s) of a local anesthetic for pain relief and healing.