How To Use HCPCS Code C9738

HCPCS code C9738 describes the use of adjunctive blue light cystoscopy with a fluorescent imaging agent. This code is used to identify and bill for this specific procedure, which is performed in addition to the primary procedure. In this article, we will explore the details of HCPCS code C9738, 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 C9738?

HCPCS code C9738 is used to identify the procedure of adjunctive blue light cystoscopy with a fluorescent imaging agent. This procedure involves the use of blue light and a fluorescent imaging agent to enhance the visualization of the bladder during cystoscopy. It is performed in addition to the primary procedure and helps in the detection and evaluation of bladder abnormalities.

2. Official Description

The official description of HCPCS code C9738 is “Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)”. The short description for this code is “Enteral supp not otherwise c”.

3. Procedure

1. The provider begins by preparing the patient for the cystoscopy procedure.
2. A cystoscope is inserted into the patient’s urethra and advanced into the bladder.
3. A fluorescent imaging agent is administered to the patient, either orally or intravenously.
4. The provider then activates the blue light source, which causes the fluorescent imaging agent to emit a fluorescent glow.
5. The bladder is examined using the blue light cystoscope, allowing for enhanced visualization of any abnormalities.
6. If any abnormalities are detected, the provider may perform additional procedures or interventions as necessary.
7. Once the procedure is complete, the cystoscope is removed, and the patient is monitored for any post-procedure complications.

4. When to use HCPCS code C9738

HCPCS code C9738 should be used when adjunctive blue light cystoscopy with a fluorescent imaging agent is performed in addition to the primary procedure. This procedure is typically used in cases where there is a suspicion of bladder abnormalities or when a more detailed evaluation of the bladder is required. It is important to note that the use of this code is subject to specific coverage instructions, as indicated by the coverage code D.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9738, healthcare providers should ensure that the procedure is properly documented in the patient’s medical record. The documentation should include details of the primary procedure, the administration of the fluorescent imaging agent, and the use of the blue light cystoscope. Additionally, any findings or abnormalities detected during the procedure should be documented. Providers should follow the specific billing guidelines provided by Medicare or other insurers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9738 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As of the provided information, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code C9738 may vary. 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. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific coverage and reimbursement guidelines.

8. Examples

Here are five examples of scenarios where HCPCS code C9738 should be billed:

1. A patient undergoes a transurethral resection of bladder tumor (TURBT) procedure, and adjunctive blue light cystoscopy with a fluorescent imaging agent is performed to enhance the visualization of any remaining tumor cells.
2. A patient with a history of bladder cancer undergoes a surveillance cystoscopy, and adjunctive blue light cystoscopy with a fluorescent imaging agent is used to detect any recurrent tumors.
3. A patient presents with hematuria, and adjunctive blue light cystoscopy with a fluorescent imaging agent is performed to evaluate the cause of the bleeding.
4. A patient with a suspected bladder abnormality undergoes a diagnostic cystoscopy, and adjunctive blue light cystoscopy with a fluorescent imaging agent is used to aid in the identification and evaluation of the abnormality.
5. A patient with a known bladder abnormality undergoes a therapeutic cystoscopy, and adjunctive blue light cystoscopy with a fluorescent imaging agent is used to guide the treatment and ensure complete removal of the abnormal tissue.