How To Use HCPCS Code C9745

HCPCS code C9745 describes a specific surgical procedure known as balloon dilation of the eustachian tube through nasal endoscopy. This code is used to identify and bill for the performance of this procedure by healthcare providers. In this article, we will explore the details of HCPCS code C9745, 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 C9745?

HCPCS code C9745 is a unique alphanumeric code that is used to identify a specific medical procedure. In this case, it represents the balloon dilation of the eustachian tube through nasal endoscopy. This procedure involves the use of a balloon catheter to dilate the eustachian tube, which is a narrow passage that connects the middle ear to the back of the throat. By dilating the eustachian tube, this procedure aims to improve the ventilation and drainage of the middle ear, thereby alleviating symptoms related to eustachian tube dysfunction.

2. Official Description

The official description of HCPCS code C9745 is “Nasal endoscopy, surgical; balloon dilation of eustachian tube.” This description accurately reflects the specific procedure that this code represents. The short description for this code is “Parenteral supp not othrws c,” which provides additional information about the nature of the procedure.

3. Procedure

1. The procedure begins with the patient being positioned appropriately for nasal endoscopy.
2. The healthcare provider inserts a nasal endoscope into the patient’s nostril to visualize the eustachian tube.
3. A balloon catheter is then guided through the nasal endoscope and positioned within the eustachian tube.
4. The balloon is inflated to dilate the eustachian tube, creating a larger opening for improved ventilation and drainage.
5. After a brief period of dilation, the balloon is deflated and removed.
6. The healthcare provider may repeat the procedure on the other side if necessary.
7. The patient is monitored for any immediate complications or adverse reactions.

4. When to use HCPCS code C9745

HCPCS code C9745 should be used when healthcare providers perform the specific procedure of balloon dilation of the eustachian tube through nasal endoscopy. This code is applicable for patients who have eustachian tube dysfunction and require this surgical intervention to alleviate their symptoms. It is important to ensure that the procedure performed aligns with the official description of the code to accurately bill for the service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9745, healthcare providers need to ensure that proper documentation is maintained to support the medical necessity of the procedure. This may include the patient’s medical history, diagnostic test results, and any other relevant information. It is essential to accurately code and document the procedure to avoid claim denials or audits. Additionally, healthcare providers should follow the billing guidelines set forth by the relevant insurance carriers or Medicare to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9745 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996. This code has a pricing indicator code of 57, which indicates that it is priced by other carriers. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology. As of December 31, 2020, this code has been terminated, and no further maintenance actions are expected.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code C9745 may vary. It is important to consult the Medicare Carriers Manual or the specific insurance carrier’s guidelines to determine coverage and reimbursement policies. The coverage code for this code is D, which indicates that special coverage instructions apply. Healthcare providers should verify the coverage and reimbursement policies with the respective payers before performing the procedure.

8. Examples

Here are some examples of scenarios where HCPCS code C9745 may be billed:

1. A 45-year-old patient presents with chronic eustachian tube dysfunction and has failed conservative management. The otolaryngologist performs balloon dilation of the eustachian tube through nasal endoscopy to alleviate the patient’s symptoms.
2. A 10-year-old child with recurrent ear infections and persistent eustachian tube dysfunction undergoes balloon dilation of the eustachian tube through nasal endoscopy as a therapeutic intervention.
3. A 60-year-old patient with a history of chronic sinusitis and eustachian tube dysfunction undergoes balloon dilation of the eustachian tube through nasal endoscopy during a sinus surgery procedure.
4. A 30-year-old patient with barotrauma-related eustachian tube dysfunction undergoes balloon dilation of the eustachian tube through nasal endoscopy to relieve symptoms and improve middle ear ventilation.
5. A 50-year-old patient with persistent ear fullness and hearing loss undergoes balloon dilation of the eustachian tube through nasal endoscopy as a standalone procedure to address the eustachian tube dysfunction.