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Thread: Dx code for depo provera shot

  1. #1
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    Default Dx code for depo provera shot

    AAPC: CPC Promo
    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!

  2. #2
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    Who is telling you that V25.49 is not an acceptable primary diagnosis? It most certainly is!
    Lisa Bledsoe, CPC, CPMA

  3. #3
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    Medicaid is not accepting it (that's the only one I've had a problem with so far!) and I checked it on EncoderPro and they also say it is not an acceptable principal dx.

  4. #4
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    that's odd the encoder would say that... the Vcode table in the ICD-9 books shows that V25.XX codes can be 1st or additional dx's. Page 19, 2009 ICD-9-CM .. print it and show it to them!

    we haven't had an issue with payment (but I'm going to double check with the patiente account reps today just to be sure)!
    Donna, CPC, CPC-H

  5. #5
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    Although encoder pro is a great product, it is not always accurate. Stick to the ICD-9 manual. I am also going to check with our Medicaid rep to see what she knows about this issue.
    Lisa Bledsoe, CPC, CPMA

  6. #6
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    Ok - THANK YOU!!

  7. #7
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    I'm in Colorado. According to the rep that handles Medicaid in our office, Medicaid does not deny for V25.49, but does deny at times due to "other rules" (she did not elaborate). But the dx is not an issue for us. Good luck!
    Lisa Bledsoe, CPC, CPMA

  8. #8
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    Our Medicaid carrier requires the family planning code V25.0- v25.09

  9. #9
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    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!
    We use V25.09 and have no problem w/reimbursement.
    Yolanda T. Haskins CPC, CRC, OHCC
    AAPCCA Board of Directors 2014 - 2017
    Region 1 - NorthEast - ME, NH, VT, MA, RI, CT, NY


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  10. #10
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    Hello:

    Keep in mind that if you use J1055 Injection, medroxyprogesterone acetate for contraceptive use, 150 mg; the V-code for contraceptive use is correct, however;

    the J1051 Injection, medroxyprogesterone acetate, 50 mg; (also depo provera but a lower dose) is not for contraceptive use. It's used as a treatment instead of contraceptive management.
    Jill Tom, COC, CPC, CPMA, CPC-I
    East Valley Kachina Coders
    East Valley Mesa, AZ AAPC Local Chapter
    President 2011
    President-Elect 2010
    New Member Development Officer 2009
    jillmtom@yahoo.com

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