HCPCS C9600: Drug-eluting stent with angioplasty, single vessel

## **HCPCS code C9600 documentation requirements** Because C9600 is a device-intensive PCI code maintained by CMS, documentation must clearly demonstrate medical necessity, compliance with coverage rules, and proper reporting under OPPS. ### **Clinical need and medical necessity** The record must establish a covered indication, such as acute myocardial infarction, unstable angina, symptomatic coronary artery disease with significant stenosis, or restenosis after prior percutaneous coronary intervention (PCI). Documentation should note the severity of stenosis (generally ≥70%, or ≥50% in the left main coronary artery) and symptoms or objective evidence of ischemia, consistent with LCD guidance. ### **Procedural details** The operative or cath lab report must describe the target vessel, balloon angioplasty performed, stent deployment technique, and number of stents placed. If more than one vessel was treated, each must be clearly identified. ### **Device description** Include details of the drug-eluting stent(s) used—manufacturer, model, size, and lot number. Affix device stickers to the chart for audit purposes. ### **Orders and compliance** Maintain a signed physician order for PCI, informed consent, and evidence of guideline-directed medical therapy when applicable. For Medicare patients, documentation should also reflect that the intervention aligns with LCD indications and limitations. ### **Pricing support** Attach the vendor invoice or device log, since C9600 is a device-intensive code and reimbursement depends on accurate cost capture.

## **HCPCS C9600 billing requirements** Billing for C9600 must follow CMS rules for PCI with drug-eluting stent placement under the Outpatient Prospective Payment System. ### **Single vessel reporting** Report one unit of C9600 per major coronary artery or branch treated with a drug-eluting stent. If multiple stents are placed in the same vessel, only one unit is reported. If another vessel is treated during the same session, use the appropriate add-on C-codes. ### **Covered indications** Payment requires documentation that the PCI meets LCD criteria, including significant stenosis with symptoms or objective ischemia, acute coronary syndromes, or restenosis after prior PCI. Procedures for non-covered indications (e.g., mild stenosis without ischemia) will be denied. ### **Units and dates** Bill one unit per vessel on the date of the PCI. The service date must match the procedure documented in the cath lab report. ### **Frequency and staging rules** When PCI is staged (e.g., second procedure within 90 days), ensure the claim reflects medical necessity and meets criteria outlined in the LCD. Submit supporting notes if the intervention was staged for clinical reasons, such as complex disease or patient stability. ### **Prior authorization and payer rules** Medicare does not require prior authorization for C9600, but many Medicare Advantage and commercial payers do. Always verify plan-specific rules before scheduling PCI, especially in the ambulatory surgery center (ASC) setting.

## **C9600 applicable modifiers** Claims for PCI must include the appropriate modifiers to identify which vessel is undergoing a specific procedure. For C9600, the following modifiers are used: - **LD**: Left anterior descending coronary artery - **LC**: Left circumflex coronary artery - **RC**: Right coronary artery - **LM**: Left main artery - **RI**: Ramus intermedius artery These modifiers ensure accurate reporting of the target vessel and are required for proper adjudication under CMS and payer guidelines.

## **Other relevant codes** - **C9601**: Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) - **C9602**: Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch - **C9603**: Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) - **C9604**: Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy, and angioplasty, including distal protection when performed; single vessel - **C9605**: Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)