Results 1 to 6 of 6


  1. Default Implants
    Medical Coding Books
    A patient comes in for procedure. Didn't know until during procedure that doctor would have to use implants. So patient did not sign sign consent for the implants. What would we do in this case?

    I appreciate any information.


  2. Default
    If patient signed consent for the procedure wouldn't anything that is necessary to complete that procedure be covered by that signature? If surgeon is in middle of procedure and realizes the implant is needed....he's not going to close patient up, wait till patient wakes up to ask permission & get sig, then give anesthesia again or even reschedule. I think if patient signed for the procedure then you are covered.

  3. Default
    Okay. I understand your point. The patient has Blue Cross and Blue Shield. The insurance will not pay for the implant. Do we bill the patient for the implants?

    I appreciate the info.

  4. #4
    I don't bill the patient, the insurance company pay implants at their discretion and usually when they deny it, it is because they consider the same included in the main procedure...interesting subject would like to hear more feed back

  5. Default
    We actually had to do a "carve-out" in our contracts with some of our biggest payors just for ortho implants. And even then I have to attach a copy of that implant ASC contract to the HCFA for each different carrier....just so they don't try & deny as "not a covered item". If you don't have those covered per your contracts...I'm so'll struggle getting reimbursed. So yes, make sure in future you've got those ABN's signed before sx "just in case". Good luck!

  6. #6
    Implants is something that certainly should be considered part of the contract. It is always best to get them carved out and reimbursed at cost + %. Some insurance companies are paying based off the Medicare allowed amounts and the reimbursement for implants are already considered, therefore no additional reimbursement will be made. You will need to review all of the current contracts by insurance company on how each handles implants.

Similar Threads

  1. Implants-Is anyone having
    By KELLI in forum Orthopaedics
    Replies: 1
    Last Post: 06-28-2012, 09:06 AM
  2. Implants-Coding an op report
    By harmoneie in forum Plastic Surgery
    Replies: 0
    Last Post: 08-08-2011, 09:03 AM
  3. Implants!
    By SS62 in forum Outpatient Facilities
    Replies: 0
    Last Post: 11-06-2008, 08:25 AM
  4. implants -overall
    By codedog in forum Outpatient Facilities
    Replies: 8
    Last Post: 08-15-2008, 11:12 AM
  5. Implants
    By jacubillas in forum Orthopaedics
    Replies: 1
    Last Post: 07-16-2007, 12:31 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.