"In the ob/gyn setting, patients are often treated for a variety of complaints through a series of injections as therapy. Injections include everything from birth control (Depo-Provera) and hormone replacement to infertility and ectopic pregnancy management. The nuances of injection coding and the accompanying evaluation and management (E/M) visits present challenges to
ob-gyn coders. Injections are always a problem, says Thomas Kent, CMM, CPC, principal of Kent Medical Management, a practice management and coding consulting firm in Dunkirk, Md. It can be difficult to gain precertification, and precertification does not guarantee payment. Payment, when received, can be below the cost of supplies.
Properly Code Injections for Birth Control
Ob/gyns who try to bill Medicare and many private carriers for injections of Medroxyprogesterone acetate (brand name Depo-Provera) for contraceptive use are likely to run into as many denials as paid claims. Although the drug has other noncontraceptive uses, including treatment for irregular periods codes 626.0 (absence of menstruation), 626.1 (scanty or infrequent menstruation), 626.2 (excessive or frequent menstruation) or 626.4 (irregular menstrual cycle) Medicare and most commercial carriers will not pay for its use as a method of contraception.
When used for contraception, Depo-Provera is administered in-office every 12 weeks. If the injection is administered by a nurse, physician assistant or nurse
practitioner, the
E/M 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) can be coded as long as the medical record shows adequate documentation that a minimal E/M service was provided. Some practices also attempt to code for the therapeutic injection using 90782 (therapeutic, prophylactic or diagnostic injection [special material injected]; subcutaneous or intramuscular), but many carriers will not pay for both the E/M and injection codes together. Practices can also code for the supply, in this case J1055 (injection, medroxyprogesterone acetate for contraceptive use, 150 mg). If the patients insurance does not recognize Depo-Provera injections as a covered charge, the patient is billed directly for the service.
Note: Medicare does not cover the cost of Depo-Provera injections when used as a contraceptive.
One way of offsetting cost to the patient for Depo-Provera injections is to have the patient procure her own supplies. In other words, a prescription is written for Depo-Provera, which the patient then has filled at her pharmacy. She returns to the ob/gyn office with the drugs for injection. If the patient has prescription coverage as part of her insurance benefits, and the [...]
