How To Use HCPCS Code C9784

HCPCS code C9784 describes a specific gastric restrictive procedure known as endoscopic sleeve gastroplasty. This procedure involves the use of an esophagogastroduodenoscopy and intraluminal tube insertion, if performed, along with all system and tissue anchoring components. It is used to treat patients who require gastric restriction for weight loss or other medical reasons. In this article, we will explore the details of HCPCS code C9784, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS C9784?

HCPCS code C9784 is a specific code used to identify the gastric restrictive procedure known as endoscopic sleeve gastroplasty. This procedure involves the use of an esophagogastroduodenoscopy and intraluminal tube insertion, if performed, along with all system and tissue anchoring components. It is typically performed to restrict the size of the stomach and promote weight loss in patients who are obese or have other medical conditions that require gastric restriction.

2. Official Description

The official description of HCPCS code C9784 is “Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components.” The short description is “Enteral supp not otherwise c.”

3. Procedure

1. The procedure begins with an esophagogastroduodenoscopy, which involves the insertion of a flexible tube with a camera into the esophagus, stomach, and duodenum to visualize the internal structures.
2. If necessary, an intraluminal tube may be inserted during the procedure. This tube is used to facilitate the gastric restrictive procedure.
3. The gastric restrictive procedure, known as endoscopic sleeve gastroplasty, is then performed. This procedure involves the use of specialized tools and techniques to reduce the size of the stomach and create a sleeve-like shape.
4. All necessary system and tissue anchoring components are utilized during the procedure to ensure the stability and effectiveness of the gastric restrictive procedure.

4. When to use HCPCS code C9784

HCPCS code C9784 should be used when billing for the specific gastric restrictive procedure of endoscopic sleeve gastroplasty. This code is applicable when the procedure includes an esophagogastroduodenoscopy and intraluminal tube insertion, if performed, along with all system and tissue anchoring components. It is important to ensure that the documentation supports the use of this code and that the procedure meets the necessary eligibility criteria or guidelines.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9784, healthcare providers should ensure that the necessary documentation is in place to support the use of this code. This may include the operative report, procedure notes, and any other relevant documentation. It is important to accurately describe the procedure performed and provide any additional information required by the payer. The billing should be done in accordance with the specific guidelines provided by the payer or insurance company.

6. Historical Information and Code Maintenance

HCPCS code C9784 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions to the code since its addition. It is important to use the most current version of the code when submitting claims or conducting medical coding.

7. Medicare and Insurance Coverage

HCPCS code C9784 may be covered by Medicare and other insurance providers. The pricing indicator code 57 indicates that the service or supply is priced by other carriers. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important to verify the coverage and reimbursement policies of the specific payer or insurance company to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9784 should be billed:

1. A 45-year-old patient with a body mass index (BMI) of 40 undergoes endoscopic sleeve gastroplasty with esophagogastroduodenoscopy and intraluminal tube insertion for weight loss purposes.
2. A 55-year-old patient with a BMI of 35 undergoes endoscopic sleeve gastroplasty with esophagogastroduodenoscopy and intraluminal tube insertion to manage obesity-related health conditions.
3. A 50-year-old patient with a BMI of 45 undergoes endoscopic sleeve gastroplasty with esophagogastroduodenoscopy and intraluminal tube insertion as part of a comprehensive weight loss program.
4. A 60-year-old patient with a BMI of 30 undergoes endoscopic sleeve gastroplasty with esophagogastroduodenoscopy and intraluminal tube insertion to address weight-related health concerns.
5. A 40-year-old patient with a BMI of 50 undergoes endoscopic sleeve gastroplasty with esophagogastroduodenoscopy and intraluminal tube insertion to improve overall health and quality of life.