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Dx code for depo provera shot

  1. #11
    North Carolina
    Medical Coding Books
    Since she is referring to a Medicaid patient, she'll need to use the diagnosis code that her local Medicaid allows.
    Rebecca CPC, CPMA, CEMC

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  2. #12
    North Carolina
    Correct...V25.49 was filed and denied. My recommendation was to check with her Medicaid carrier since our Medicaid carrier requires the family planning codes for depo...V25.0-V25.09 (which ever is applicable). As you know, Medicaid doesn't follow traditional guidelines (for the most part)
    Rebecca CPC, CPMA, CEMC

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  3. #13
    Default Cpc
    Hi. I code OB Antepartum for Medicaid patients. I agree with the Initial or the Subsequent contraception code under V25.02 or V25.49 as the primary code for the depo injection. I believe that Medicaid pays for the shot only if that was what she was there for. The family planning advice could/would be secondary under a family planning encounter for pregnancy test or advice for the contraception, if not provided at the visit.

  4. #14
    North Carolina
    Noted but difference in opinion.
    Rebecca CPC, CPMA, CEMC

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  5. #15
    Default Injecton
    We have found that Medicaid requires the NDC number of the drug to be listed on the claim for any drug that is injected. We use 96372 with v25.49 and J1055 with the ndc number and they are getting paid.

  6. #16
    we've always used V25.8 for depo shots for birth control and all have gotten paid by all carriers.

  7. #17
    This thread is probably old and forgotten, but I wanted to add a note about EncoderPro.

    This is what it says about V25.49: Unacceptable Principal Dx (for Inpatient Services)

    Since it's not an inpatient service, it shouldn't affect reimbursement.
    Heidi Thompson, CPC

  8. Red face depo provera
    Quote Originally Posted by mm0105 View Post
    Hello. I just recently came across a problem when billing depo provera injections. I know that the code changed from 90772 to 96372, however the problem that i am encountering is the diagnosis code. Previously i was using v25.49 but now it is saying that v25.49 is an unacceptable primary dx. What should i be using? Thanks in advance for any help given!
    I use v25.02 for initiation of other contaceptive measures

  9. #19
    Portland Rose City Oregon Chapter
    The diagnosis code our office uses is V25.40. This never gets denied and we always are paid. You must have the NDC number and enter the number of units given to get the claim paid.
    Amber Ruiz, CPC
    Women's Health Today

  10. #20
    Default depo provera
    What code should we use for the medication? Since J1055 has been deleted?
    Raquel G

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