Question 1

What is HCPCS code C9796?

Accepted Answer

HCPCS code C9796 is "Rpr intst excl anrect fist". Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis])

Question 2

What category is C9796 in?

Accepted Answer

C9796 belongs to HCPCS Category C (CMS Hospital Outpatient Payment).

Question 3

When should I use HCPCS code C9796?

Accepted Answer

Use C9796 when billing for rpr intst excl anrect fist. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is C9796 covered by Medicare?

Accepted Answer

Coverage for C9796 (Rpr intst excl anrect fist) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for C9796?

Accepted Answer

Documentation for C9796 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).