# Dx code for depo provera shot



## mm0105

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!


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## Lisa Bledsoe

Who is telling you that V25.49 is not an acceptable primary diagnosis?  It most certainly is!


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## mm0105

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.


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## dmaec

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)!


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## Lisa Bledsoe

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.


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## mm0105

Ok - THANK YOU!!


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## Lisa Bledsoe

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!


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## RebeccaWoodward*

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


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## LOVE2CODE

mm0105 said:


> 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.


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## jillmtom

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.


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## RebeccaWoodward*

Since she is referring to a Medicaid patient, she'll need to use the diagnosis code that her local Medicaid allows.


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## RebeccaWoodward*

Correct...V25.49 was filed and denied.  My recommendation was to check with her Medicaid carrier since our Medicaid carrier requires the family planning codes for depo...V25.0-V25.09 (which ever is applicable).  As you know, Medicaid doesn't follow traditional guidelines (for the most part)


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## BarbSlattery

*Cpc*

Hi.  I code OB Antepartum for Medicaid patients.  I agree with the Initial or the Subsequent contraception code under V25.02 or V25.49 as the primary code for the depo injection.  I believe that Medicaid pays for the shot only if that was what she was there for.  The family planning advice could/would be secondary under a family planning encounter for pregnancy test or advice for the contraception, if not provided at the visit.


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## RebeccaWoodward*

Noted but difference in opinion.


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## barbacasec

*Injecton*

We have found that Medicaid requires the NDC number of the drug to be listed on the claim for any drug that is injected. We use 96372 with v25.49 and J1055 with the ndc number and they are getting paid.


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## hunters

we've always used V25.8 for depo shots for birth control and all have gotten paid by all carriers.


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## hthompson

This thread is probably old and forgotten, but I wanted to add a note about EncoderPro.

This is what it says about V25.49: Unacceptable Principal Dx (for Inpatient Services)

Since it's not an inpatient service, it shouldn't affect reimbursement.


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## scurtis68

*depo provera*



mm0105 said:


> 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!



I use v25.02 for initiation of other contaceptive measures


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## AMBERRUIZ

The diagnosis code our office uses is V25.40. This never gets denied and we always are paid. You must have the NDC number and enter the number of units given to get the claim paid.


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## rgonzalez16

*depo provera*

What code should we use for the medication? Since J1055 has been deleted?


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## twinpw

Raquel G, I would use J1050. The following was copied from ACOG. Hope this helps clarify:
Changes in Depo Provera Coding
 HCPCS codes J1051 (Injection, medroxyprogesterone acetate, 50 mg), J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) and J1056 (Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg) have been discontinued as of December 31, 2012. 

Effective January 1, 2013, injection administration of medroxyprogesterone acetate (Depo-Provera) should be reported using HCPCS code J1050 (Injection, medroxyprogesterone acetate, 1 mg). Due to the change in dosage from the discontinued codes, when reporting code J1050, the appropriate dosage (measured in units) should be reported based on the specific needs of the patient. 

Report the injection administration in addition to CPT code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). However, per CPT, it is not appropriate to report injection administration code 96372 without direct physician or other qualified health care professional supervision, unless administered in a hospital setting. In that case, report instead, 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 or other qualified health care professional), if applicable.


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## abctibbett@gmail.com

*Injection fee*

I can't get Medicaid to pay for the injection code for DepoProvera, 96372. Is anyone using a different code?


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## barbarat

In Georgia, Medicaid is now requiring an office visit accompany the depo (at least a 99211 with the J1050).  ICD9 code V25.09.  We have no problem with reimbursement if we have the 992xx.


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