Ob-Gyn Coding Alert

The use of the contraceptive Norplant presents some interesting reimbursement challenges for the ob/gyn coder, says Jean Stoner, CPC, and Paula Ziemski, CPC, coding trainers for UPMC Health System, Pittsburgh, PA. Unlike other contraceptives, Norplant involves procedures for both insertion and removal, which may be combined with exams and office visits.

While some controversy continues around the use of Norplant, a recent publication released by the AMA states, Norplant is one of the most effective reversible methods of birth control available in the U.S. Part of Norplants appeal is it provides an effective means of contraception that is not dependent upon a patients vigilant compliance (as with contraceptive pills and other devices). Norplant is a hormonal implant that slowly releases levonorgestrel (a hormone similar to a womans own progesterone). It becomes effective within 24 hours of insertion and protects against pregnancy for five years. Only four women out of 100 who use Norplant for five years will become pregnant a rate less than one per year. Yet another appeal of Norplant is its reversible effects. Within a few hours after the implants are removed, Norplants effects disappear and conception is possible.

Unlike many contraceptives that do not involve the coder (because the physician simply writes a prescription or provides advice), Norplant involves procedures for both insertion and removal. The contraceptive comes in six Silastic capsules or packets about the size of match sticks that are placed under the skin in the patients arm. All six of the small rubbery implants are needed and constantly release small amounts of hormone into the patients body. The hormone keeps the ovaries from releasing eggs. It also thickens the cervical mucus, keeping sperm from joining with an egg or (some researchers suggest) by preventing a fertilized egg from attaching to the lining of the uterus.

The insertion of Norplant involves the administration of a local anesthetic and a single small incision site to place all six capsules under the skin. Insertion takes about 10 minutes. It is painless, except for the needle prick of the painkiller, although some women report feeling some discomfort for a while after insertion. Norplant can be inserted immediately after an abortion or following childbirth if the patient is not breast-feeding (six weeks after childbirth if patient is breast-feeding). Patients will be advised to make a follow-up visit within the first three months after insertion and once a year after that. Removal or replacements of the implants involve another small incision and takes a little longer than the original insertion.

Norplant Coding Scenarios

According to Stoner and Ziemski, the procedure codes used for Norplant are: 11975 (insertion, implantable contraceptive capsules), 11976 (removal, implantable contraceptive capsules), 11977 (removal and reinsertion, implantable contraceptive capsules). These [...]