CPT codes for insertion of subcutaneous pellet implant

Receipt

Patient Name: ____________________________________

Date of Birth: ______________

Procedure Date: ___________________________________

ICD 9 Codes: 259.9, 257.2, 780.79
 

 

Description Fee

 CPT Code: 11980,  J3490,  A4550

 Implantation of hormone implants beneath the skin $Unclassified Drug. __________ Hormone implants (pellets) & Supplies. $__________

Total Charges $____________

Total Payments ____________

Balance__________________

 

 Procedure Report

The procedure, risks, benefits and alternatives to the procedure were explained to the patient. Questions were answered and a consent for ‘the insertion of hormone pellets’ was signed.
An area in the _________ was prepped with alcohol solution. 1% lidocaine with epinephrine was used to anestitize the area. The area was re-prepped. A small transverse incision was made using a number 11 blade. The trochar with cannula was passed through the incision into the subcutaneous tissue. ________ mg testosterone pellet(s) and ________ mg estradiol pellet were inserted through the cannula into the subcutaneous tissue. Bleeding was minimal. A sterile dressing was applied. The patient tolerated the procedure well. Post operative instructions were given to the patient.
6/07