Essure billing

Need help with Essure billing.
We are billing: 58565 & L8699. The L8699 is being denied as included. Any help would be great! Thank you.

Essure billing

If you check the CMS prodecure/device edits for 58565, it does show that there is no suitable device reportable for this procedure code. Likely, this is the reason that the payer is denying L8699 as included.

If you are billing for just the MD, the reportable device belongs to the facility claim, not the MD claim.

Essue Billing

Thank you very much for your assistance!

Essure Billing

Look at code A4264. This is a new HCPCS code for 2010 for the device(s)
and delivery system.