How To Use CPT Code 11980

CPT 11980 refers to the subcutaneous hormone pellet implantation procedure, which involves the insertion of hormone pellets beneath the skin to treat menopausal symptoms in women or testosterone deficiency in males. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11980.

1. What is CPT 11980?

CPT 11980 is a medical procedure code that describes the subcutaneous hormone pellet implantation. This procedure involves the insertion of hormone pellets beneath the skin, typically under the patient’s arm, to release synthetic hormones such as testosterone and/or estradiol. These hormones help treat menopausal symptoms in women and testosterone deficiency in males.

2. 11980 CPT code description

The official description of CPT code 11980 is: “Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)”.

3. Procedure

The CPT 11980 procedure involves the following steps:

1. Administration of local anesthesia to the patient.
2. Making a subcutaneous/subdermal incision with a trocar.
3. Using forceps to create a space for the hormone pellets.
4. Inserting the hormone pellets into the created space.
5. Closing the incision and applying a dressing to the wound.

4. Qualifying circumstances

Patients eligible to receive CPT code 11980 services include:

• Women experiencing menopausal symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness.
• Males with testosterone deficiency, which can lead to symptoms such as fatigue, decreased libido, and muscle weakness.
• Patients who have not responded well to other hormone replacement therapies or have contraindications for other treatments.
• Patients who prefer a long-lasting, steady release of hormones over other methods of hormone replacement therapy.

5. When to use CPT code 11980

It is appropriate to bill the 11980 CPT code when a healthcare provider performs the subcutaneous hormone pellet implantation procedure for the treatment of menopausal symptoms in women or testosterone deficiency in males. The code should be used only for the insertion of the hormone pellets and does not include the cost of the hormone pellets themselves.

6. Documentation requirements

To support a claim for CPT 11980, the following information should be documented:

• Patient’s medical history and symptoms indicating the need for hormone pellet implantation.
• Physical examination findings and any relevant laboratory test results.
• Details of the procedure, including the type and number of hormone pellets inserted.
• Post-procedure care instructions and follow-up plan.
• Any complications or adverse reactions encountered during or after the procedure.

7. Billing guidelines

When billing for CPT code 11980, keep in mind the following guidelines:

• Ensure that the patient’s medical record supports the medical necessity of the procedure.
• Include the appropriate diagnosis codes to justify the need for hormone pellet implantation.
• Bill separately for the cost of the hormone pellets, as the CPT 11980 code only covers the insertion procedure.
• Be aware of any payer-specific requirements or policies related to billing for hormone pellet implantation.

8. Historical information

CPT 11980 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates to the code since its addition.

9. Similar codes to CPT 11980

Five similar codes to CPT 11980 and how they differ are:

• CPT 11981: This code refers to the insertion of a non-biodegradable drug delivery implant, which is used for contraception or other purposes, rather than hormone pellet implantation.
• CPT 11982: This code is for the removal of a non-biodegradable drug delivery implant, not hormone pellet implantation.
• CPT 11983: This code covers the removal and reinsertion of a non-biodegradable drug delivery implant, not hormone pellet implantation.
• CPT 96372: This code is for the administration of a therapeutic, prophylactic, or diagnostic injection, not hormone pellet implantation.
• CPT 20605: This code refers to the aspiration or injection of a joint or bursa, not hormone pellet implantation.

10. Examples

Here are 10 detailed examples of CPT code 11980 procedures:

1. A 52-year-old woman with severe hot flashes and night sweats undergoes hormone pellet implantation to alleviate her menopausal symptoms.
2. A 65-year-old man with testosterone deficiency and decreased libido receives hormone pellet implantation to improve his symptoms.
3. A 48-year-old woman with a history of hysterectomy and oophorectomy undergoes hormone pellet implantation for hormone replacement therapy.
4. A 55-year-old woman with contraindications to oral hormone replacement therapy receives hormone pellet implantation to manage her menopausal symptoms.
5. A 60-year-old man with fatigue and muscle weakness due to testosterone deficiency undergoes hormone pellet implantation to improve his symptoms.
6. A 50-year-old woman with a history of breast cancer and menopausal symptoms receives hormone pellet implantation as an alternative to other hormone replacement therapies.
7. A 58-year-old man with erectile dysfunction and low testosterone levels undergoes hormone pellet implantation to increase his testosterone levels.
8. A 45-year-old woman with premature ovarian failure and severe menopausal symptoms receives hormone pellet implantation for hormone replacement therapy.
9. A 70-year-old man with osteoporosis and testosterone deficiency undergoes hormone pellet implantation to improve his bone density and overall health.
10. A 53-year-old woman with a history of blood clots and menopausal symptoms receives hormone pellet implantation as a safer alternative to other hormone replacement therapies.