How To Use HCPCS Code C9788

HCPCS code C9788 describes the procedure of opto-acoustic imaging of the breast, including the axilla when performed, on a unilateral basis. This imaging technique involves the use of ultrasound examination to obtain images, which are then documented, analyzed, and reported. The code was added to the Healthcare Common Procedure Coding System on January 1, 1985, and its termination date is set for December 31, 2023.

1. What is HCPCS C9788?

HCPCS code C9788 is used to identify the specific procedure of opto-acoustic imaging of the breast. This imaging technique combines the use of ultrasound and laser-induced sound waves to create detailed images of the breast tissue. The procedure includes the examination of the axilla, if performed, and the documentation, analysis, and reporting of the obtained images.

2. Official Description

The official description of HCPCS code C9788 is “Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The opto-acoustic imaging procedure begins with the patient positioning themselves in a comfortable position, usually lying on their back.
2. The healthcare provider applies a gel-like substance to the breast area to facilitate the transmission of sound waves.
3. An ultrasound transducer is then placed on the breast, emitting sound waves and receiving the echoes produced by the breast tissue.
4. Simultaneously, laser pulses are delivered to the breast tissue, generating opto-acoustic signals.
5. The opto-acoustic signals are detected by the ultrasound transducer and converted into images.
6. The obtained images are documented, analyzed, and reported by the healthcare provider.

4. When to use HCPCS code C9788

HCPCS code C9788 should be used when a healthcare provider performs opto-acoustic imaging of the breast, including the axilla if performed, on a unilateral basis. This code is specific to the imaging technique described and should not be used for other breast imaging procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9788, healthcare providers should ensure that the following documentation is included:

• A detailed description of the opto-acoustic imaging procedure performed
• The documentation, analysis, and report of the obtained images
• The indication of whether the axilla was included in the imaging procedure

Providers should follow the appropriate billing guidelines and submit the necessary documentation to support the medical necessity of the procedure.

6. Historical Information and Code Maintenance

HCPCS code C9788 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996, and no maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code. The code is priced by other carriers, as indicated by the pricing indicator code 57, and the multiple pricing indicator code A, which means it is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

HCPCS code C9788 is assigned the coverage code D, which indicates that special coverage instructions apply. Medicare and other insurance providers may have specific guidelines and criteria for the coverage and reimbursement of this procedure. Providers should consult the Medicare Carriers Manual Reference Section Number 2130 for further information on coverage and billing requirements.

8. Examples

Here are five examples of scenarios where HCPCS code C9788 may be billed:

1. A 45-year-old female presents with a suspicious breast lump. The healthcare provider performs opto-acoustic imaging of the breast, including the axilla, to assess the nature of the lump and document the findings.
2. A patient with a history of breast cancer undergoes regular follow-up examinations. As part of the follow-up, opto-acoustic imaging of the breast is performed to monitor any changes in the breast tissue.
3. A patient with a family history of breast cancer undergoes opto-acoustic imaging of the breast as a preventive measure to detect any early signs of the disease.
4. A patient presents with breast pain and discomfort. Opto-acoustic imaging of the breast is performed to evaluate the underlying cause of the symptoms.
5. A patient with a known breast abnormality undergoes opto-acoustic imaging to guide a biopsy procedure and ensure accurate targeting of the affected area.