Wiki Nexplanon Removal

Please provide a description of the procedure performed (ie, providers notes) so we can better help you with this.
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.
 
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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?
 
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?
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.
 
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.
Thank you a ton as always!
 
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.
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?
 
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.
 
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?
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.
 
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?
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

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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.
Thank you!
 
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.
Thank you!
 
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