Implant billing

Donna SanGiovanni

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Hamden, Ct
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My ASC has always had trouble getting paid for implants.. One problem I am faced with is that it is my understanding Medicare's definition of an implant is a device that replaces a body part. ex- prosthetic hip /knee .... Our payer contracts include the "words" implant reimbursement at a percentage.. My Director insisted that kwires, screws, pins etc.. are implants. Our carriers view them as supplies and denied payment. We do not have a DME supplier number. Could anyone out there reply to this...

Thank you.
 

CoderChick24

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Columbus, OH
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I think a lot of ASCs have the same problem.

You are right about Medicare'sdefinition though.... An implant is something that replaces a body part. (Although sometimes coming to an agreement over that definition is hard!) Screws, etc. are considered supplies.
 

Valdezcg

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Local Chapter: Dallas Central Chapter (Dallas, TX)
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In my experience of working in the ASC's, I too saw the same denials on k-wire's etc. However, when we got our DME license they paid for them. When you realistically look at it, the provider could not have successfully performed the procedure without the k-wire's etc. therefore, it's part of the procedure. And since medicare does make a clear distinction between an implant and supply, technically they feel they are not liable to reimburse.
This in no way implies that I agree with medicare, but just trying to offer an explanation as to why they are doing this to the majority of the ASC's across the US. thanks, Connie
 

bbates

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Do you send an invoice with the claim? What code do you use when you bill them?
 

bbates

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Most insurance companies will only accept the L8699 code. We have luck with payment when sending a copy of the invoice and the peri op report showing the implant was used on the patient. An or employee will put a sticker from the implant used on the back of the peri op report that goes in the patient's chart. Find out if your center uses an implant log. Ask for a copy at the end of each week.
 

bbates

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Also find out if you are contracted with your payers to receive additional reimbursement for implants.
 

Donna SanGiovanni

Networker
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Hamden, Ct
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We submit with L8699 and send in invoice, opnote. Many of our contracts work off of Medicare's- we have it in the contracts we will get reimbursed for IMPLANTS, but things like kwires, screw, plates are not considered implants per Medicare's definition- therefore, no pay. We do not have a DME number... I am trying to get the contracts that are up for renegotiations to include these items spelled out in the contract itself.

Thanks to all of you for your suggestions

Donna SanGiovanni, CPC
President/Founder of Hamden Chapter 20307
 

cconroycpch

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Palm Beach
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You are correct about Medicare, but your other contracts should have an implant carve out based upon the cost of the implant. Most insurance companies will reimburse for the pins/screws/anchors, but probably not k-wires and they are so cheap. They will also probably want you to use CPT code 99070 on a HCFA 1500 or rev code 274/275/278 if billing on a UB.
 

mbort

True Blue
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ENGLEWOOD/DENVER
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ASC Implants

An important thing to remember when billing implants to Medicare is that box 19 on the HCFA needs to be filled out, there needs to be a description of the imiplant as well as the "actual" cost. This will help detour some of the denials. We still have some issues, but this has seemed to help.

Mary
 

Deadpd

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Salt Lake City
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implant billing

I've had good success billing for screws with a C1713, mesh with a C1781, etc.... There are some payers that only will take the 99070 though. I allways send a copy of the invoice along with the bill to show what it was and how much it cost. You might want to try that.
 

dbrosnan

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Donna,

Medicare does not pay for implants in the ASC with the exception of very few codes. The hardware that you are referring to is the pass through code C1713. This code is payable in the hospital setting only.

While I agree with your manager they are implants. Medicare at this time considers them part of the service performed and included in your reimbursement. I was hopping that with the coming of APC's in the ASC world we would get implants. Only to find out, this is still just a dream. Even with the new payment method coming, Medicare still will not pay for hardware implants such as k-wires, plates, screws, nails, or anchors.

This was discuss on the grassroots national forum with Medicare back in September when they had open floor discussion about the APC payments.
 

mbort

True Blue
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Is there another code besides L8699 for a Kwire. I have researched and unable to find one. but someone insist that is not a coder telling us that there is a code.

Thanks
Kathy
kphilp@praxishg.com
no there is not another code for K-wires, L8699 is what mst use unless your contract requires you to use 99070 which I have seen before.

This thread is wayyyyyyyyy outdated now from 2007 so information previously posted prior to your inquiry may be outdated as well
 

sbw

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Bayfield, CO
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Implant Billing.

As an ASC we bill plates/screws/guidewire under the L8699 HCPCS code and with almost all payers we supply an implant log/invoice and the operative notes. Recently it has been brought to our attention that drill bits/k-wires and the like cannot be billed because they aren't actually "implants". Although these items are not actually left in the body they are included in the implant trays that our vendors supply. We thought it made sense to bill these items because they are a part of the implant sets. Does anyone have any thoughts on this? We can't get a clear answer.

Also, can implant in/outs (waste) be billed? I have heard that as long as the implant touched the patient it can be billed.

Any thoughts would be much appreciated.
 
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