How To Use HCPCS Code C9899

HCPCS code C9899 describes an implanted prosthetic device that is payable only for inpatients who do not have inpatient coverage. This code is used to identify the provision of enteral supplies that are not otherwise classified. In this article, we will explore the details of HCPCS code C9899, 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 C9899?

HCPCS code C9899 is used to identify an implanted prosthetic device that is payable only for inpatients who do not have inpatient coverage. This code is specifically used for enteral supplies that are not otherwise classified. It is important to note that this code is applicable only for inpatient services and not for outpatient or ambulatory care settings.

2. Official Description

The official description of HCPCS code C9899 is “Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. Implantation of the prosthetic device: The healthcare provider performs the surgical procedure to implant the prosthetic device in the patient’s body. This may involve making an incision, creating a pocket for the device, and securing it in place.
2. Verification of inpatient status: The healthcare provider ensures that the patient meets the criteria for inpatient status and does not have inpatient coverage.
3. Documentation: The healthcare provider documents the details of the procedure, including the type of prosthetic device implanted and any relevant information regarding the patient’s inpatient status.

4. When to use HCPCS code C9899

HCPCS code C9899 should be used when an implanted prosthetic device is provided to an inpatient who does not have inpatient coverage. It is important to verify the patient’s inpatient status and ensure that they meet the specific criteria for this code. This code is not applicable for outpatient or ambulatory care settings.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9899, healthcare providers need to ensure proper documentation of the procedure and the patient’s inpatient status. It is important to include detailed information about the implanted prosthetic device and any relevant supporting documentation. The documentation should clearly indicate that the patient does not have inpatient coverage.

6. Historical Information and Code Maintenance

HCPCS code C9899 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 falls under the pricing indicator code 57, which indicates that it is priced by other carriers. The multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology.

7. Medicare and Insurance Coverage

HCPCS code C9899 is subject to special coverage instructions, as indicated by the coverage code D. This means that specific guidelines or criteria apply when determining the coverage for this code. Medicare and other insurance providers may have their own policies regarding the reimbursement for this code. It is important to review the Medicare Carriers Manual reference section number 2130 for further guidance on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9899 should be billed:

1. An inpatient without inpatient coverage receives an implanted prosthetic device for enteral support.
2. A patient admitted to the hospital for a specific procedure requires an implanted prosthetic device for enteral support during their stay.
3. An inpatient with a medical condition that necessitates enteral support receives an implanted prosthetic device.
4. A patient undergoing a complex surgical procedure requires an implanted prosthetic device for enteral support during their hospitalization.
5. An inpatient with a chronic illness that requires long-term enteral support receives an implanted prosthetic device.