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Thread: Implanon Codes

  1. #1
    Join Date
    Apr 2007
    Location
    Salem, NH
    Posts
    36

    Default Implanon Codes

    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

  2. #2
    Join Date
    Apr 2007
    Location
    Kansas City, MO
    Posts
    736

    Default

    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.
    Angela Jordan, CPC
    AAPC of Kansas City, Region 5 - Southwest
    Medical Revenue $olutions
    Managing Consultant

    angela@medicalrevenuesolutions.com

  3. #3
    Join Date
    Apr 2007
    Location
    Alexandria VA/Orlando FL
    Posts
    11

    Default 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.

    Last edited by tcruz; 01-13-2011 at 12:13 PM. Reason: additional information to clarify my question

  4. #4

    Default

    Medicare will not pay for contraception.

  5. #5

    Default

    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?

  6. #6
    Join Date
    Apr 2007
    Location
    Kingsport,TN
    Posts
    11

    Default implanon J7307 Medicare

    Does anyone have any additional suggestions?
    Last edited by Hite; 04-20-2012 at 12:33 PM.

  7. #7
    Join Date
    Apr 2007
    Location
    Grand Rapids
    Posts
    144

    Default

    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.
    Leandra Tufts, CPC, CEMC, COBGC

  8. #8

    Default

    11976 and 11981 are the correct codes for 2012 (and are to be used together when removing and reinserting) and are allowed by Medicare.

  9. #9

    Default

    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?

  10. #10

    Default

    In 2012 CPT 11975 was dropped. The correct code to use for Implanon is now 11981.

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