Ob-Gyn Coding Alert

Reader Questions:

Nexplanon Infection May Mean Opting for Patient Relations

Question: Our ob-gyn saw the patient for two visits a month apart. The first was for the insertion of the Nexplanon (11981/J7307). Then weeks later, she came in, and the Nexplanon was found to be too superficial and now infected. So, the ob-gyn removed and re-inserted in other arm (11983-52 (reduced service to reduce charge since it’s not really patient’s fault for infection)/ J7307 + T85.79xA for diagnosis code.

Patient is still stuck with paying for the drug itself x2, and Nexplanons are quite expensive. What should I do in this scenario?

Iowa Subscriber

Answer: You should not use modifier 52 (Reduced services) in this case, because there was no reduction in service. If the error was provider-caused, you should consider eating the cost of the of the Nexplanon replacement and insertion as a gesture of good patient relations. Coding cannot fix this issue for you.

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