tfypoo
New
A patient was seen to have 2 Nexplanon devices removed. Can you bill the removal procedure twice?
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Wiki Nexplanon Removal
- Thread starter tfypoo
- Start date
nielynco
True Blue
Please provide a description of the procedure performed (ie, providers notes) so we can better help you with this.
tfypoo
New
HPI - The patient presents today for Nexplanon removal. She has two devices in place in her left arm. She was previously counseled, and all questions have been answered to her satisfaction.
Procedure Documentation -
Risks, benefits, indications and alternatives for the procedure were reviewed with the patient. All questions were answered. Informed consent was obtained. Post-care instructions were given to the patient.
Patient desires the removal of the device and was informed fertility will resume.
The insertion site was identified, and cleaned with Betadine. Local anesthesia was achieved with both topical anesthetic and Lidocaine 1% with Epi. A scalpel was used to incise the skin over the implant's distal end of the rod and was milked toward skin incision. A small hemostat was used to grasp and remove the implant.
A standard dressing was then applied over the insertion site. A pressure bandage was also applied.
The patient was instructed to remove the pressure dressing in 24 hours.
The patient tolerated the procedure well. She was monitored per protocol and discharged home after meeting criteria.
Last edited:
nsteinhauser
Expert
Have you looked at 11982?
tfypoo
New
Yes that is the code we use for a Nexplanon removal. My question is since the patient has 2 Nexplanon implants in her arm can I bill 11982 twice.
tfypoo
New
Thank you!
Korbc
Expert
does anyone know how to charge for a removal and insertion and removal again in the same visit because she had numbness from hitting a nerve when they reinserted the new one so immediately removed the new one.
also I was told you could get reimbursement from the manufacturer for the Nexplanon and told to charge the device to insurance. but i would think if we're getting reimbursed from the manufacturer not to charge insurance because wouldn't that be double dipping?
also I was told you could get reimbursement from the manufacturer for the Nexplanon and told to charge the device to insurance. but i would think if we're getting reimbursed from the manufacturer not to charge insurance because wouldn't that be double dipping?
nielynco
True Blue
I would report 11983 with a modifier -22 if the removal time was significant. If is was just slipped in and immediately slipped out I think I would report 11983 with no modifier. If you are being reimbursed by the manufacturer you should not be billing insurance. But you could bill insurance, and if they refuse to pay, contact the manufacturer.
Korbc
Expert
Thank you a ton as always!
Yjrieken
Contributor
No one is asking about charging and E/M code. So I'm curious. My providers are charging a 99212. Does anyone else charge e/m codes with insertion, removal or both?
I would charge an E&M only if an E&M was provided. At whatever level was documented. Always a 99212 (or any "always" level) makes me raise an eyebrow.
From the original poster here, the documentation supplied was a procedure only and would not support any E&M level.
Korbc
Expert
Unless there's a separate issue addressed and enough e/m for it then I don't charge an e/m. There's a small amount of e/m already built into procedures already, so if they are there for just that and it's just the procedure I just charge the procedure. Also often times counseling done regarding the procedure was done prior to the visit for my practice.
ACOG has a LARC coding guideline, but to reiterate what was said above, a provider should not be standardly charging an E+M in this situation. Here is a snip from a PDF version
Yjrieken
Contributor
Thank you!
Yjrieken
Contributor
Thank you!
Yjrieken
Contributor
Thank you!
Korbc
Expert
i forget what does 1 mean again? i have the same scenario, could i bill for the removal twice in the same session because she had 2 in her arm?
From CMS https://www.cms.gov/medicare/coding...tive-ncci-edits/medicare-ncci-faq-library#mue
2. What is a Medically Unlikely Edit (MUE)?
An MUE is a unit of service edit for a Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code for services rendered by a single provider/supplier to a single beneficiary on the same date of service. An MUE is the maximum unit(s) of service that would be reported for an HCPCS/CPT code on the vast majority of appropriately reported claims. MUEs are adjudicated either as claim line edits or date of service edits. Not all HCPCS/CPT codes have an MUE. (See question five for guidance on reporting medically reasonable and necessary services in excess of an MUE value for claim line edits.)
3. Are there NCCI Medicare date of service MUEs and Claim Line MUEs for HCPCS/CPT codes?
There are both date of service and claim line MUEs. CMS publishes which codes have a date of service and which codes have claim line MUEs. For date of service MUEs, the claims processing system sums all units of service (UOS) on all claim lines with the same HCPCS/CPT code and date of service. The MUE files on the CMS NCCI web page display an MUE Adjudication Indicator (MAI) for each HCPCS/CPT code. An MAI of “1” indicates that the edit is a claim line MUE. An MAI of “2” or “3” indicates that the edit is a date of service MUE. Further information is available in MM8853 (PDF).
4. How are claims adjudicated with MUEs?
MUEs are either claim line edits or date of service edits. If the MUE is a claim line edit, each line of a claim is adjudicated against the MUE value for the HCPCS/CPT code on that claim line. If the UOS on the claim line exceeds the MUE value, all UOS for that claim line are denied. If the same code is reported on more than one line of a claim by using CPT modifiers, each line of the claim is adjudicated separately against the MUE value of the code on that claim line.
If the MUE is a date of service MUE, all UOS for the HCPCS/CPT code reported by the same provider/supplier for the same beneficiary for the same date of service are summed. The summed value is compared to the MUE value. If the sum is greater than the MUE value, all UOS for the code on the current claim are denied.
5. How do I report medically reasonable and necessary Units of Service (UOS) in excess of an MUE value?
For MUEs that are adjudicated as claim line edits, each line of a claim is adjudicated separately against the MUE value for the code on that line. The appropriate use of HCPCS/CPT modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary UOS in excess of a claim line edit. Further information is available in MM8853 (PDF).
2. What is a Medically Unlikely Edit (MUE)?
An MUE is a unit of service edit for a Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code for services rendered by a single provider/supplier to a single beneficiary on the same date of service. An MUE is the maximum unit(s) of service that would be reported for an HCPCS/CPT code on the vast majority of appropriately reported claims. MUEs are adjudicated either as claim line edits or date of service edits. Not all HCPCS/CPT codes have an MUE. (See question five for guidance on reporting medically reasonable and necessary services in excess of an MUE value for claim line edits.)
3. Are there NCCI Medicare date of service MUEs and Claim Line MUEs for HCPCS/CPT codes?
There are both date of service and claim line MUEs. CMS publishes which codes have a date of service and which codes have claim line MUEs. For date of service MUEs, the claims processing system sums all units of service (UOS) on all claim lines with the same HCPCS/CPT code and date of service. The MUE files on the CMS NCCI web page display an MUE Adjudication Indicator (MAI) for each HCPCS/CPT code. An MAI of “1” indicates that the edit is a claim line MUE. An MAI of “2” or “3” indicates that the edit is a date of service MUE. Further information is available in MM8853 (PDF).
4. How are claims adjudicated with MUEs?
MUEs are either claim line edits or date of service edits. If the MUE is a claim line edit, each line of a claim is adjudicated against the MUE value for the HCPCS/CPT code on that claim line. If the UOS on the claim line exceeds the MUE value, all UOS for that claim line are denied. If the same code is reported on more than one line of a claim by using CPT modifiers, each line of the claim is adjudicated separately against the MUE value of the code on that claim line.
If the MUE is a date of service MUE, all UOS for the HCPCS/CPT code reported by the same provider/supplier for the same beneficiary for the same date of service are summed. The summed value is compared to the MUE value. If the sum is greater than the MUE value, all UOS for the code on the current claim are denied.
5. How do I report medically reasonable and necessary Units of Service (UOS) in excess of an MUE value?
For MUEs that are adjudicated as claim line edits, each line of a claim is adjudicated separately against the MUE value for the code on that line. The appropriate use of HCPCS/CPT modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary UOS in excess of a claim line edit. Further information is available in MM8853 (PDF).
Korbc
Expert
so sorry i know in summary it's how many units or times you can charge for something the blip in there regarding the "1" isn't clear to me does that mean when there is a "1" it can only be reported once with 1 unit?
Korbc
Expert
i just i guess need to know if i can bill for the nexplanon removal twice because she had 2 of them, if only once in from same incision or if twice if 2 separate incsions etc. thank you so much