How To Use HCPCS Code C9760

HCPCS code C9760 describes a non-randomized, non-blinded procedure for patients with NYHA class II, III, or IV heart failure. This procedure involves the transcatheter implantation of an interatrial shunt, which is performed as part of an approved investigational device exemption (IDE) study. The procedure includes various components such as right and left heart catheterization, transeptal puncture, and imaging with or without guidance, such as ultrasound or fluoroscopy. It is important to note that this procedure is not applicable for emergency situations and is specifically intended for patients participating in an IDE study.

1. What is HCPCS C9760?

HCPCS code C9760 is a specific code used to identify the non-randomized, non-blinded procedure for patients with NYHA class II, III, or IV heart failure. This code is used to describe the transcatheter implantation of an interatrial shunt, which is performed as part of an approved investigational device exemption (IDE) study. The procedure involves various components, including right and left heart catheterization, transeptal puncture, and imaging with or without guidance. It is important to note that this code is not applicable for emergency situations and is specifically intended for patients participating in an IDE study.

2. Official Description

The official description of HCPCS code C9760 is “Non-randomized, non-blinded procedure for NYHA class II, III, IV heart failure; transcatheter implantation of interatrial shunt, including right and left heart catheterization, transeptal puncture, 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 for HCPCS code C9760 involves several steps:

• Right and left heart catheterization: The provider performs catheterization of both the right and left sides of the heart to assess the patient’s cardiac function and obtain necessary measurements.
• Transeptal puncture: A puncture is made in the atrial septum to create an opening for the interatrial shunt.
• Trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE): The provider uses either TEE or ICE to visualize the heart and guide the placement of the interatrial shunt.
• Imaging with or without guidance: The procedure may involve additional imaging techniques, such as ultrasound or fluoroscopy, to assist in the placement of the interatrial shunt.

4. When to use HCPCS code C9760

HCPCS code C9760 should be used when documenting and billing for the non-randomized, non-blinded procedure of transcatheter implantation of an interatrial shunt in patients with NYHA class II, III, or IV heart failure. It is important to note that this code is specifically intended for use in approved investigational device exemption (IDE) studies and is not applicable for routine clinical practice or emergency situations.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9760, healthcare providers should ensure that the necessary documentation is in place to support the performance of the procedure. This may include detailed procedure notes, imaging reports, and any other relevant documentation. It is also important to follow the specific billing guidelines provided by the payer or insurance company to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9760 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. The 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. 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 coverage for HCPCS code C9760 may vary depending on the specific circumstances and guidelines set forth by Medicare. It is important to consult the Medicare Carriers Manual or other relevant resources for specific coverage instructions and requirements. Additionally, other insurance providers may have their own coverage policies and pricing methodologies for this code.

8. Examples

Here are five examples of when HCPCS code C9760 should be billed:

1. A patient with NYHA class II heart failure participates in an approved investigational device exemption (IDE) study and undergoes the transcatheter implantation of an interatrial shunt.
2. A patient with NYHA class III heart failure is enrolled in an IDE study and undergoes the non-randomized, non-blinded procedure of transcatheter implantation of an interatrial shunt.
3. An individual with NYHA class IV heart failure is included in an IDE study and receives the transcatheter implantation of an interatrial shunt as part of the study protocol.
4. A patient with NYHA class II, III, or IV heart failure is eligible for an IDE study and undergoes the non-randomized, non-blinded procedure of transcatheter implantation of an interatrial shunt.
5. An individual with NYHA class II, III, or IV heart failure is enrolled in an IDE study and receives the transcatheter implantation of an interatrial shunt, including all necessary components such as right and left heart catheterization, transeptal puncture, and imaging.