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Diagnosis: Coding Primary Diagnosis S-Codes 1
This section includes the Family PACT (Planning, Access, Care and Treatment) primary diagnosis
S-codes used for billing all Family PACT services.
Primary Diagnosis S-Code In place of the limited ICD-9-CM V codes for contraceptive services in
Required on Claims the ICD-9-CM code book, Family PACT has a unique S-code system
that is used for the diagnosis of family planning methods. These
codes are used to identify the primary family planning and
complication services covered by the program. Primary family
planning services include evaluation prior to a family planning method
choice, and surveillance while continuing to use a family planning
method.
Claims for Family PACT services must contain a primary diagnosis
S-code. Family PACT claims are required to have an S-code in the
primary diagnosis field of the claim form.
Note: Do not use an ICD-9-CM code in the primary diagnosis field of
the claim.
Primary Family Planning Primary Family PACT benefits are categorized according to the
Benefits following eight family planning methods.
S-Code
Category Description
S10 Oral contraceptives, contraceptive patch and vaginal ring
S20 Contraceptive injections
S30 Contraceptive implants
S40 Intrauterine contraceptives
S50 Barrier/fertility awareness methods
S60 Pregnancy testing only
S70 Bilateral Tubal Ligation (BTL) – female sterilization
S80 Vasectomy – male sterilization
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
October 2007
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The fourth and fifth digits in an S-code provide a higher level of
specificity in the following ways:
The addition of a one (1) in the fourth position indicates
“evaluation prior to method, with or without the initiation of a
method.”
The addition of a two (2) in the fourth position means to
“maintain adherence and surveillance.”
The addition of a three (3) in the fourth position indicates
“treatment for complication of a treatment or procedure that is
either method-specific or for a secondary related reproductive
health condition.”
The addition of a number (1, 2, 3, 4 or 5) in the fifth position
indicates the highest level of specificity for diagnosis
Gender Restrictions Family PACT primary diagnosis codes are categorized and restricted
as follows.
S-Codes Gender
S101 – S4033 Females
S501 – S5031 Males and Females
S601 – S602 Females
S701 – S7034 Females
S801 – S8033 Males
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
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FAMILY PLANNING METHODS
The following S-codes are used to bill for family planning benefits.
Oral Contraceptive, Patch S-Code Description
and Vaginal Ring S101 Oral contraception, patch and vaginal ring; evaluation
prior to method, with or without initiation of method
S102 Oral contraception, patch and vaginal ring; maintain
adherence and surveillance
S103 Oral contraception, patch and vaginal ring; treatment for
vasovagal episode or complication due to treatment for
secondary related reproductive health condition
S1031 Deep vein thrombosis or Pulmonary embolism
associated with use of estrogen containing hormonal
contraception.
Contraceptive Injection S-Code Description
S201 Contraceptive Injection; evaluation prior to method, with
or without initiation of method
S202 Contraceptive injection; maintain adherence and
surveillance
S203 Contraceptive injection; treatment for vasovagal episode
or complication due to treatment for secondary related
reproductive health condition
S2031 Heavy vaginal bleeding due to use of contraceptive
injection
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
October 2007
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Contraceptive Implant S-Code Description
S301 Contraceptive implant; evaluation prior to method, with
or without initiation of method
S302 Contraceptive implant; maintain adherence and
surveillance, including removal/reinsertion
S303 Contraceptive implant; treatment for vasovagal episode
or complication due to treatment for secondary related
reproductive health condition
S3031 Missing or deep capsule or surgical removal of deep
capsule
S3032 Infection at insertion/removal site
S3033 Hematoma at implant insertion/removal site
S3034 Capsule expulsion
S3035 Heavy bleeding due to implant
Intrauterine Contraceptives S-Code Description
(IUC) S401 IUC; evaluation prior to method, with or without initiation
of method
S402 IUC; maintain adherence and surveillance
S403 IUC; treatment for vasovagal episode or complication
due to treatment for secondary related reproductive
health condition
S4031 Pelvic infection secondary to IUC
S4032 Evaluation for missing IUC
S4033 Perforated or translocated IUD/IUS
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
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Barriers and Spermicide, S-Code Description
Natural Family Planning S501 Barriers and spermicide, NFP, FAM, LAM; evaluation
(NFP), Fertility Awareness prior to method, with or without initiation of method
Methods (FAM), Lactation
Amenorrhea Method (LAM) S502 Barriers and spermicide, NFP, FAM, LAM; maintain
adherence and surveillance
S503 Barriers and spermicide, NFP, FAM, LAM; treatment for
vasovagal episode or complication due to treatment for
secondary related reproductive health condition
S5031 Evaluation of severe skin/tissue reaction (by
dermatologist)
PREGNANCY TESTING
The following S-codes are used to bill for pregnancy testing.
Pregnancy Testing S-Code Description
S601 Pregnancy testing only
S602 Confirmation of pregnancy test results with physical
examination
If the client does not choose a family planning method, bill the
pregnancy test and visit using the primary diagnosis S-codes S601 or
S602. If the client chooses a family planning method, bill the visit and
the pregnancy test using the primary diagnosis of the client’s method
(for example, if the client leaves the clinic with oral contraceptives, bill
the visit and the pregnancy test using the primary diagnosis code
S101). If the pregnancy test is positive, the client is not eligible for any
other benefits of the program except the required education and
counseling. For more information, refer to the Office Visits:
Evaluation and Management and Education and Counseling section in
this manual.
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
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STERILIZATION
The following S-codes are used to bill for sterilization services.
Bilateral Tubal Ligation (BTL) S-Code Description
S701 BTL; screening and evaluation
S702 BTL procedure
S703 BTL; treatment for vasovagal episode or complication
due to treatment for secondary related reproductive
health condition
S7031 BTL; anesthesia complication requiring an overnight
hospital stay
S7032 BTL; suspected/known abdominal injury (within 30 days
postoperative)
S7033 BTL; operative site infection (within 30 days
postoperative)
S7034 Preoperative evaluation of a medical condition to rule out
surgical contraindications (TAR required)
Vasectomy S-Code Description
S801 Vasectomy; screening and evaluation
S802 Vasectomy procedure
S803 Vasectomy; treatment for vasovagal episode or
complication due to treatment for secondary related
reproductive health condition
S8031 Vasectomy; testicular/spermatic cord hematoma, or
hemorrhage (within 30 days postoperative)
S8032 Vasectomy; acute infection at operative site (within 30
days postoperative)
S8033 Vasectomy; evaluation of postoperative testicular pain
(within 30 days postoperative)
Diagnosis: Coding Primary Diagnosis S-Codes Family PACT 1
October 2007