Correct coding for evaluation to determine infertility

Posted October 7, 2014

If a patient and partner present to our office with a six-month or one-year history of failure to conceive with no previous testing or treatment, we have been using the V26.21 diagnosis code, as it seems to be most appropriate for the male and female diagnostic testing phase, such as semen analysis, sonohysterogram and egg quality testing.

It seems that giving a female infertility code such as 628.x or 606.x for male infertility would be inappropriate because we don’t know yet who is infertile. We have only recently started having problems with this code and only with one major commercial insurer who is stating that we should be using the infertility codes. so it has now raised the question: are we in the right?
 

Twin pregnancy and transvaginal/transabdominal ultrasound

Posted September 8, 2014

When a patient becomes pregnant with twins following an IUI or IVF cycle, we have been billing CPT 76817 for the early monitoring ultrasound on the first sac and 76817 -59 for the additional sac examined in the multiple pregnancy, during the same encounter. We have never had a problem getting paid for both ultrasounds done on the same day when the diagnosis is 651.03 twin pregnancy. 

Recently, Horizon Blue Cross and Blue Shield has denied payment for the ultrasound done on the second sac, stating denial is based on “payment methodology and guidelines” and that 76817 can only be billed once per encounter. The CPT book neither states that the code can or can’t be billed twice per exam. 

I have read the description of the other pregnancy codes that specifically state they can be used more than once per exam, and they involve greater work than we can provide at this early stage of monitoring. Do you have any thoughts, and is BCBS correct in denying payment for the second ultrasound exam?

Diagnostic hysteroscopy when no abnormalities are found

Posted September 4, 2014

What ICD-9 code do you use if a diagnostic hysteroscopy is performed for the preoperative diagnosis of uterine polyp but the postoperative diagnosis is normal uterine cavity? The hysteroscopy was performed to evaluate for a uterine polyp, but no polyp was seen.

Elective oocyte preservation

Posted September 4, 2014

What would the correct ICD-9 codes be, and in what sequence would they fall, for a single female patient who would like to do a stimulation cycle with oocyte retrieval and resulting cryopreservation for future personal use? This patient is 36 years old with no medical problems and wishes to preserve her oocytes for future use. Her third-party payer indicates that she does have coverage for these services.

Coding for test transfer of embryo catheter in a patient with previous cancer surgery

Posted September 4, 2014

How would you code for an ultrasound- guided transvaginal-transmyometrial test transfer of embryo catheter?

This patient has a history of cervical cancer with radical trachelectomy and abdominal cerclage. She has uterine segment stenosis, and has been trying to conceive for more than 6 months with previous failed attempts of intrauterine cannulation. The patient was taken to the OR for exam under anesthesia, intrauterine cannulation, and test transfer of transmyometrial embryo catheter.

Follicular monitoring for a PCO patient undergoing fertility treatment

Posted September 4, 2014

We have a patient insisting that we code the ultrasound follicle monitoring with the PCOS diagnosis. The patient has PCOS, but is now undergoing fertility treatment to get pregnant. My understanding is that if the patient is undergoing treatment to get pregnant, we code with either the 628 codes or the V26.89, and the PCOS can be a secondary diagnosis. Is this correct?

Code for semen leukocyte analysis or reflex leukocyte assay

Posted September 4, 2014

What CPT code is applicable for a Semen Leukocyte Analysis or a Reflex Leukocyte Assay?

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