How To Use HCPCS Code C9758

HCPCS code C9758 describes a blinded procedure for NYHA class III/IV heart failure. This code is specifically used for transcatheter implantation of an interatrial shunt or placebo control, including right heart catheterization, trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (IDE) study.

1. What is HCPCS C9758?

HCPCS code C9758 is a specific code used to identify a blinded procedure for NYHA class III/IV heart failure. It is used when a transcatheter implantation of an interatrial shunt or placebo control is performed as part of an approved investigational device exemption (IDE) study. This code encompasses various procedures, including right heart catheterization, trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy).

2. Official Description

The official description of HCPCS code C9758 is “Blinded procedure for NYHA class III/IV heart failure; transcatheter implantation of interatrial shunt or placebo control, including right heart catheterization, trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (IDE) study.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The procedure begins with the right heart catheterization, which involves the insertion of a catheter into the right side of the heart to measure pressures and obtain blood samples.
2. Trans-esophageal echocardiography (TEE) or intracardiac echocardiography (ICE) is then performed to visualize the heart and assess its function.
3. The next step is the transcatheter implantation of an interatrial shunt or placebo control. This involves the placement of a device to create a shunt between the atria of the heart or the placement of a placebo device for control purposes.
4. All necessary imaging, such as ultrasound or fluoroscopy, is performed during the procedure to guide the placement of the device.
5. It is important to note that this procedure is performed as part of an approved investigational device exemption (IDE) study, which means it is being conducted for research purposes.

4. When to use HCPCS code C9758

HCPCS code C9758 should be used when performing a blinded procedure for NYHA class III/IV heart failure. This code is specifically for the transcatheter implantation of an interatrial shunt or placebo control, including right heart catheterization, TEE/ICE, and all imaging with or without guidance. It is important to ensure that the procedure is being performed as part of an approved investigational device exemption (IDE) study.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9758, healthcare providers need to document the details of the procedure, including the right heart catheterization, TEE/ICE, and any imaging performed. It is important to include the documentation of the investigational device exemption (IDE) study and the purpose of the procedure. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9758 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. This code falls under the special coverage instructions category (HCPCS Coverage Code D) and is priced by other carriers (HCPCS Pricing Indicator Code 57).

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code C9758 may vary. It is important to check with the specific insurance provider for coverage details and reimbursement rates. 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 follow the guidelines and requirements set by the insurance company for proper reimbursement.

8. Examples

Here are five examples of when HCPCS code C9758 should be billed:

1. A patient with NYHA class III heart failure undergoes a transcatheter implantation of an interatrial shunt as part of an approved investigational device exemption (IDE) study.
2. A patient with NYHA class IV heart failure receives a placebo control device implantation as part of an approved investigational device exemption (IDE) study.
3. A patient with NYHA class III/IV heart failure undergoes right heart catheterization, TEE/ICE, and imaging as part of the procedure for transcatheter implantation of an interatrial shunt or placebo control.
4. A healthcare provider performs a blinded procedure for NYHA class III/IV heart failure, including right heart catheterization, TEE/ICE, and imaging, as part of an approved investigational device exemption (IDE) study.
5. A patient with NYHA class III/IV heart failure receives a transcatheter implantation of an interatrial shunt or placebo control, with all necessary imaging and guidance, as part of an approved investigational device exemption (IDE) study.