How To Use HCPCS Code C9764

HCPCS code C9764 describes a specific procedure known as revascularization, endovascular, open or percutaneous, of the lower extremity artery(ies), except tibial/peroneal, with intravascular lithotripsy. This code is used to identify the use of intravascular lithotripsy in conjunction with angioplasty within the same vessel(s) during the revascularization procedure. It is important for medical coders to understand the details and guidelines associated with this code to ensure accurate billing and reimbursement.

1. What is HCPCS C9764?

HCPCS code C9764 is a specific code used to identify the procedure of revascularization, endovascular, open or percutaneous, of the lower extremity artery(ies), except tibial/peroneal, with intravascular lithotripsy. This procedure involves the restoration of blood flow to the lower extremity arteries using various techniques, including open surgery or minimally invasive percutaneous interventions. The addition of intravascular lithotripsy involves the use of specialized devices to break up calcified plaque within the arteries, allowing for better angioplasty outcomes.

2. Official Description

The official description of HCPCS code C9764 is “Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The provider begins by accessing the lower extremity artery(ies) through an open surgical approach or percutaneously using a catheter-based technique.
2. If there is significant calcified plaque within the artery, the provider may choose to perform intravascular lithotripsy. This involves the use of a specialized device that emits sonic pressure waves to break up the calcified plaque.
3. After intravascular lithotripsy, the provider performs angioplasty within the same vessel(s) to further open up the artery and improve blood flow.
4. The procedure may involve the use of stents or other devices to maintain vessel patency.
5. The provider ensures hemostasis and closes the incisions or access sites.

4. When to use HCPCS code C9764

HCPCS code C9764 should be used when the provider performs revascularization of the lower extremity artery(ies), except tibial/peroneal, using intravascular lithotripsy in conjunction with angioplasty within the same vessel(s). It is important to note that this code specifically excludes tibial/peroneal arteries, so it should not be used for procedures involving these arteries.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9764, healthcare providers should ensure that the medical documentation supports the use of intravascular lithotripsy and angioplasty within the same vessel(s) during the revascularization procedure. The documentation should clearly describe the procedure performed, including any specific details or challenges encountered. Additionally, providers should follow the billing guidelines set forth by Medicare or other insurance carriers to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9764 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

HCPCS code C9764 is assigned a pricing indicator code of 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. It is important for healthcare providers to check with Medicare or other insurance carriers to determine coverage and reimbursement rates for this specific procedure.

8. Examples

Here are five examples of when HCPCS code C9764 should be billed:

1. A patient with severe peripheral artery disease undergoes revascularization of the lower extremity artery(ies) using intravascular lithotripsy and angioplasty within the same vessel(s).
2. A diabetic patient with critical limb ischemia requires intervention to restore blood flow in the lower extremity artery(ies). The provider performs intravascular lithotripsy and angioplasty within the same vessel(s) during the procedure.
3. A patient with chronic lower extremity arterial occlusion undergoes revascularization using intravascular lithotripsy and angioplasty within the same vessel(s).
4. A patient with a history of lower extremity arterial stenosis experiences recurrent symptoms and requires revascularization. The provider utilizes intravascular lithotripsy and angioplasty within the same vessel(s) to improve blood flow.
5. A patient with peripheral artery disease and calcified plaque in the lower extremity artery(ies) undergoes a revascularization procedure that includes intravascular lithotripsy and angioplasty within the same vessel(s).