How To Use HCPCS Code C9785

HCPCS code C9785 describes the procedure of endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components. This code is used to identify a specific medical service provided by healthcare providers. In this article, we will explore the details of HCPCS code C9785, 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 C9785?

HCPCS code C9785 is a specific code used in medical coding to identify the procedure of endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components. This code is used to accurately represent this particular medical service in healthcare claims and billing processes.

2. Official Description

The official description of HCPCS code C9785 is “Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The procedure of HCPCS code C9785 involves endoscopic outlet reduction and gastric pouch application.
2. An endoscopy is performed to visualize the gastric pouch and identify the area that requires reduction.
3. If necessary, an intraluminal tube is inserted to assist in the reduction process.
4. All system and tissue anchoring components are included in this procedure.

4. When to use HCPCS code C9785

HCPCS code C9785 should be used when healthcare providers perform the specific procedure of endoscopic outlet reduction and gastric pouch application, along with the use of endoscopy and intraluminal tube insertion, if applicable. This code is used to accurately document and bill for this particular medical service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9785, healthcare providers need to document the details of the procedure, including the use of endoscopy and intraluminal tube insertion, if performed. It is important to include all system and tissue anchoring components in the documentation. Proper documentation ensures accurate billing and reimbursement for the provided service.

6. Historical Information and Code Maintenance

HCPCS code C9785 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 has remained unchanged since its addition to the coding system.

7. Medicare and Insurance Coverage

HCPCS code C9785 is covered by Medicare. 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. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for more specific information on coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code C9785 should be billed:

1. A patient undergoes endoscopic outlet reduction and gastric pouch application with the use of endoscopy and intraluminal tube insertion for weight loss management.
2. A healthcare provider performs endoscopic outlet reduction and gastric pouch application with the use of endoscopy and intraluminal tube insertion to address complications after a previous gastric bypass surgery.
3. A patient with a history of obesity and gastrointestinal issues undergoes endoscopic outlet reduction and gastric pouch application with the use of endoscopy and intraluminal tube insertion for symptom management.
4. A healthcare provider performs endoscopic outlet reduction and gastric pouch application with the use of endoscopy and intraluminal tube insertion as part of a research study on bariatric procedures.
5. A patient with a gastric pouch obstruction undergoes endoscopic outlet reduction and gastric pouch application with the use of endoscopy and intraluminal tube insertion for relief of symptoms.