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Implant code L8699

  1. #1
    Unhappy Implant code L8699
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    I am getting denials from Aetna on L8699. It states implant code L8699 denied for as experimental or investigational. They used to pay for this an now they are not.

    Thanks,
    Jenny,CPC

  2. #2
    Default
    It may have something to do with your contract. I do not have a problem with that. what implant was it?
    LG CPC,CASCC

  3. #3
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    There are several Implants one is for shoulder replacement CPT code 23472 for a prosthetic implant. Another one is a VariAx plate and DBS bone putty. I am checking to see if the contract has been changed.

    Thanks,
    Jenny,CPC

  4. #4
    Default
    wouldn't the plate and bone putty be c1713?

    CMS Device Code Definition - Implantable pins and/or screws that are used to oppose soft tissue-to-bone, tendon-to-bone, or bone-to-bone. Screws oppose tissues via drilling as follows: soft tissue-to-bone, tendon-to-bone, or bone-to-bone fixation. Pins are inserted or drilled into bone, principally with the intent to facilitate stabilization or oppose bone-to-bone. This may include orthopedic plates with accompanying washers and nuts. This category also applies to synthetic bone substitutes that may be used to fill bony void or gaps (i.e., bone substitute implanted into a bony defect created from trauma or surgery).
    LG CPC,CASCC

  5. #5
    Default
    I tried that too but Aetna will not accept the C1713.
    Jenny, CPC

  6. #6
    Default
    Well... it sounds like either they want it billed with a different revenue code or its a contractual thing...... Did you call them and ask what is the issue? Because you are allowed to obtain the coding edits they use....
    LG CPC,CASCC

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