Wiki Nexplanon insert after delivery

[TanBro]

I keep getting denials from BCBS for the Nexplanon insert 11981 during the post partum visit. No charge for the post partum visit, j7307 for the Nexplanon and 11981-79 for the insert. (I've tried 78 as well). They keep bundling the insertion. Any one have any tips I can use to get this to pay?

 

[nielynco]

I keep getting denials from BCBS for the Nexplanon insert 11981 during the post partum visit. No charge for the post partum visit, j7307 for the Nexplanon and 11981-79 for the insert. (I've tried 78 as well). They keep bundling the insertion. Any one have any tips I can use to get this to pay?

You have billed correctly so you will need to appeal. Have you also checked to see if there is some other modifier that must be applied such as for contraceptive services? Have you referenced their provider manual for maternity and gyn services? Did you indicate a different date of service, and bill it on a separate claim? If all else fails, appeal the denial.

 

[rstroup]

I thought perhaps they might be bundling with the delivery code with postpartum care included but per my resource, there is no NCCI edit so no modifier should be required. Did you initially bill 11981 without a modifier? If not, I would remove the 79. Otherwise, check the payer policy.

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Ryan Stroup, CPC

 

[natashalage]

sorry, I am not an expert. It seems like it should be billed without modifier. I would check NCCI if there is a bundling issue between 11981 and your delivery code. Maybe -58 as a staged procedure? -78 is return to OR, I don't think Nexplanon was done in OR. These are my thoughts.