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Implant billing

  1. #1
    Default Implant billing
    Medical Coding Books
    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.

  2. #2
    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.

  3. #3
    Local Chapter: Dallas Central Chapter (Dallas, TX);
    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

  4. #4
    Do you send an invoice with the claim? What code do you use when you bill them?

  5. #5
    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.

  6. #6
    Also find out if you are contracted with your payers to receive additional reimbursement for implants.

  7. #7
    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

  8. #8
    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.

  9. Default
    I'm lost when it comes to implants! Does anyone know of a site with info?

  10. #10
    Default 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.


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