Summary & Overview
HCPCS Level II C9749: Repair of Nasal Vestibular Lateral Wall Stenosis with Implant(s)
Headline: HCPCS Level II code C9749: Repair of nasal vestibular lateral wall stenosis with implant(s)
Lead: HCPCS Level II code C9749 identifies a surgical procedure to repair nasal vestibular lateral wall stenosis using implants to maintain airway patency. The code captures a specialized otolaryngology intervention that addresses functional nasal obstruction caused by lateral wall collapse or stenosis.
This code matters nationally as implant-based nasal vestibular repairs are increasingly used to treat persistent nasal obstruction when conservative measures fail, impacting surgical utilization, device supply, and payer coverage policies. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn clinical context for the procedure, typical sites of service, and what to expect in payer coverage discussions. The publication provides benchmarks and policy-relevant information on billing and coding for this implant-supported nasal vestibular repair, highlights common modifiers used with the code, and flags where input data is incomplete. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9749 describes repair of nasal vestibular lateral wall stenosis with implant(s). The service involves surgical correction of narrowing in the lateral wall of the nasal vestibule, with placement of one or more implants to restore or maintain airway patency.
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Service type: Surgical repair with implant placement
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Typical site of service: Ambulatory surgical center or hospital outpatient/surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic with symptomatic nasal obstruction localized to the lateral vestibular wall (alar rim or vestibular stenosis) often following prior nasal surgery, trauma, or prolonged device use. Symptoms include unilateral or bilateral nasal airflow limitation, crusting, recurrent localized infections, and impaired nasal breathing affecting sleep and activity. Evaluation includes history, anterior rhinoscopy, endoscopic nasal exam, and nasal breathing assessment (such as Cottle or modified Cottle maneuvers). Imaging is not routinely required but may be used if deeper structural issues are suspected.
The clinical workflow: initial outpatient evaluation by an otolaryngologist or facial plastic surgeon; conservative measures (topical therapies, intranasal steroids, saline, and intranasal dilators) trialed first. When symptoms persist and objective exam confirms lateral vestibular wall stenosis, the patient is scheduled for operative repair under monitored anesthesia care or general anesthesia in an ambulatory surgery center or hospital operating room. The procedure involves excision or release of stenotic scar, placement of an implant or stent (autologous graft, cartilage, or synthetic implant) to lateralize and support the vestibular wall, and suturing. Postoperative care includes nasal saline irrigations, topical ointments, short course antibiotics if indicated, and follow-up visits for implant assessment and potential removal if temporary. Typical sites of service are ambulatory surgery centers and hospital outpatient departments; select cases may be performed in-office under local anesthesia if minor and patient-appropriate.
Coding Specifications
| Modifier | Description | When to Use |
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