Let’s increase our use of implants and DMPA and improve contraceptive effectiveness in this country

• 11981 (Insertion, non-biodegradable drug delivery implant)
• linked to the diagnosis code V25.5 (Insertion of implantable subdermal contraceptive).

A caveat. You should be aware, however, that if a patient comes in for removal of Norplant capsules and has a Nexplanon rod inserted at the same encounter, CPT instructions are to report 11976 and 11981. That means you will submit a claim with 11976 linked to diagnosis code V25.43 (Surveillance of previously prescribed contraceptive methods; implantable subdermal contraceptive) and 11981-51 (Insertion, non-biodegradable drug delivery implant; multiple procedures) linked to diagnosis code V25.5. As with all multiple procedures, the highest valued code is always listed first to maximize reimbursement.

In-office insertion. When the insertion is performed in the office setting, the relative value is higher due to the increased practice expense and includes the drug supply (J7307, Etonogestrel (contraceptive) implant system, including implant and supplies). Unless your payer is not reimbursing using relative value units, you should not be coding the implant system separately. Be sure to check payer guidelines to avoid payment delays and possible denials for this supply.

DMPA

When a patient selects an injectable contraceptive instead of the subdermal implant, coding becomes more straightforward. The injection procedure is reported using:

• 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular)
• J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg).

Note that CPT rules do not allow reporting code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services) with the injection code. If a separate significant E/M service is provided at the time of the visit (meaning 99201-99205 for new patient visits, or 99212-99215 for established patient visits), a modifier -25 must be added to the E/M service or the injection procedure will be denied as bundled. The injection code also requires direct physician supervision. If the billing provider is not in the office at the time of the injection and an RN administers the injection, code 99211 is billed instead of 96372. Keep in mind, however, that this might mean that some payers will deny the injection procedure under “incident to” rules for ancillary services.

—Melanie Witt, RN, CPC, COBGC, MA

Ms. Witt is an independent coding and documentation consultant and former program manager, department of coding and nomenclature, American Congress of Obstetricians and Gynecologists.