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Implanon Codes

barbacasec

Networker
Messages
36
Location
Salem, NH
Best answers
0
Does anyone know which CPT codes are supposed to be used for the insertion and removal of the new Implanon device? I have two different providers and they both have different ideas on which ones should be used. Dr 1 says 11981, 11982 and 11983
Dr 2 says 11975,11976, and 11977

they both make sense - is one better than the other?

thanks
 

amjordan

True Blue
Messages
751
Location
Blue Springs, MO
Best answers
0
I would go with the 11975 - 11977 because it is for contraception. The information below can be found in the 2002 CPT Changes book.

11981 “Insertion, non-biodegradable drug delivery implant”
would not be the appropriate code to use for the insertion of
contraceptives. Code 11975 “Insertion, implantable contraceptive
capsules” directly relates to contraceptives and is the
correct code to use.


Hope this information helps.
 

tcruz

Contributor
Messages
11
Location
Clermont, FL
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0
Implanon and Medicare

I am having a difficult time with billing Implanon to medicare. I have used 11981,J7307 with dx V25.5 and this is denying. I am at a total loss because I have no clue what I am doing wrong. Can you or anyone offer any advice? I have tried researching the CMS website and still nothing......

The denial reason states that;
N56: Procedure code billed is not correct/valid for the services billed or the date of service billed;
These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.

But this was the only thing done during the visit! I have called them and I don't get anywhere.

:confused:
 
Last edited:

klacross

New
Messages
2
Best answers
0
We also have the same problem with the denial code that Medicare gives us. We can not bill the patient's secondary (Mass Health) because they will not accept this denial code from Medicare and we are stuck in the middle. Have you received any suggestions yet that work?
 

Leandra

Guru
Messages
162
Location
Grand Rapids
Best answers
0
FYI - 11975 is a deleted code. We use 11981 for the insertion of Implanon and have no problem getting it paid.

I am not sure about the Medicare issue. Can you bill Medicare for denial to get a "proper denial" that the 2nd insurance will accept in order to process the claim for payment? When I worked in home infusion we had to bill Medicare for denial quite often for our IVIG patients.
 

Bready

Guru
Messages
155
Best answers
1
11976 and 11981 are the correct codes for 2012 (and are to be used together when removing and reinserting) and are allowed by Medicare.
 
Messages
3
Best answers
0
I have been billing V25.5 as the diagnosis for the Implanon and now Tricare states that the diagnosis is inconsistent with the procedure. Any suggestions?
 

Bready

Guru
Messages
155
Best answers
1
In 2012 CPT 11975 was dropped. The correct code to use for Implanon is now 11981.
 
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