Wiki implant codes in ASC C1713 vs L8699

[pochranek]

I am trying to determine which is the more appropriate code to use for implants in our ASC setting. We use anchors, screws, cannulas, drills and tubular plates

Thank you!!

 

[delphinus777]

In my experience it comes down to the carrier you are billing. How they prefer you to bill it. Also if you have contract I would check them. I've only billed out implants with the L code and supplies with the A4649 as well as some drugs with the C codes. I've seen other coders bill using the C codes or 99 series. Keep in mind that most supplies that are integral to the surgical procedure are included in the reimbursment for the ASC. {such as the drill, drill bits and cannula}.

 

[pochranek]

Thank you for your reply! I appreciate the input! It can be challenging with the implants and I had actually forgotten about the A4649 code.

 

[KDCOWGIRL]

I use C1713 for anchors and screws and don't have a problem. I use L8699 for bone and tendon grafts. Hope this helps.

 

[pochranek]

Thank you! Do you ever use A4649 miscellaneous surgical supplies? For the trays or anything like that?

 

[armen]

I am trying to determine which is the more appropriate code to use for implants in our ASC setting. We use anchors, screws, cannulas, drills and tubular plates
Thank you!!

We use 99070, some people use L8699. try to use specific codes if possible. in your example C1713 is ok for anchors but not for plates. If there is no specific code then use one of the misc codes.

Different payors will require different codes

 

[KDCOWGIRL]

I used to use A4649 but since most of my charges are for screws/anchors c1713 is more appropriate. I don't use 99070 because that specifically says "provided by physician" and I am billing for the facility not for the physician.

 

[armen]

I used to use A4649 but since most of my charges are for screws/anchors c1713 is more appropriate. I don't use 99070 because that specifically says "provided by physician" and I am billing for the facility not for the physician.

we use 99070 fos ASC as a misc supply code. Not every payer reimburses implants separatelly and the once who pays usually did not have any problems with it.

 

[delphinus777]

Trays.....

Thank you! Do you ever use A4649 miscellaneous surgical supplies? For the trays or anything like that?

Well, you'll probably get a different answer from every coder...but as far as misc. supplies go and the A4649 code, I bill out supplies that are beyond the normal reimbursement. A good example would be the Novasure device used in GYN procedures. The reimbursement for the procedure doesnt cover the cost of the device [which can range over $1000.00]. This would be something you would work out in a contract with a carrier or just see if the carrier would reimburse for it. Of course medicare does not cover these supplies. The surgical trays are considered "integral to the surgical procedure"......BUT depending on how your workers comp and Auto claims pay, you might consider billing them out to them just to see if they reimburse for them. Good luck.

 

[bethh05]

The use of 99070 for our facility resulted in audits and refund requests. We bill high cost supplies with L8699 and revenue code 0279(other supplies/devices). With the use of accessories (needed to assist in the insertion of function of a device) we add the cost into the cost of the device/implant.
Orthopedic plates can be billed with C1713.Here is a link from the CMS:
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospital

 

[armen]

The use of 99070 for our facility resulted in audits and refund requests. We bill high cost supplies with L8699 and revenue code 0279(other supplies/devices). With the use of accessories (needed to assist in the insertion of function of a device) we add the cost into the cost of the device/implant.
Orthopedic plates can be billed with C1713.Here is a link from the CMS:
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospital

the link does not work, can you repost?

 

[bethh05]

Sorry try this:
http://www.cms.gov/Medicare/Medicar...tientPPS/downloads//DeviceCats_OPPSUpdate.pdf
On page 5 for the description of C1713 includes Orthopedic plates and synthetic bone substitutes.

 

[battilea]

implants

What makes an implant and implant. In other words is there a time limit that an implant has to stay in the body for it to be considered a billable item. We don't bill for supplies (A4649) but our contracts allow us to bill for implants (L8699) for example