Specific Procedures

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.

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.

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?

Billing for multiple procedures during laparoscopy

Posted February 10, 2014

Is it appropriate to bill for medically indicated, multiple procedures when performing laparoscopies? For example, we occasionally perform fimbrioplasties or large paratubal or ovarian cyst removals (indication infertility) when lasering endometriosis (indication pelvic pain). 

Can we submit them with the appropriate modifiers (e.g., –51 or –59)? The sites, as well as the indications, are different. There is no requirement by CMS to bundle according to the tables. I do understand that the reimbursements are typically reduced, but that is ok for the purpose of the question. 

Billing 89250 and 89251 on separate days of the same cycle

Posted January 3, 2014

Can codes 89250 and 89251 be billed on different days of the same cycle? We understand that both codes cannot be billed on the same day of service. However, is it compliant to bill 89250 in addition to 89251 on separate days of service?

Can I Bill Separately for Interpretation of Semen Analysis Results?

Posted December 17, 2013

My IVF lab does a full semen analysis with strict morphology. I do a formal interpretation of the results mentioning quality parameters and I also give recommendations, such as: repeat semen analysis, obtain cultures, needs endocrine evaluation, needs IUI, and needs IVF/ICSI.

Can I bill for my services? If so, under what CPT code? What would the RVU be?

Best code for laparoscopic tubal anastomosis?

Posted December 17, 2013

What is the correct CPT code for laparoscopic tubal anastomosis with robotic assistance?   AAPC is stating this procedure is an unlisted code. What is your opinion?   Because the operative report must accompany the surgery claim to the insurance carrier, we also believe the third-party payers will agree with the unlisted code as correct coding.

Code for "scratch test"

Posted August 12, 2013

What CPT code should be used for a “scratch test”? This is essentially an endometrial biopsy in the luteal phase prior to one’s in vitro fertilization (IVF) cycle or frozen embryo transfer (FET) cycle. I am curious if the Coding Committee has any comment on whether or not these procedures are coded as an endometrial biopsy and, if not, how? Cervical dilation? 

 

How to code ultrasound follicle checks and labs for IUI after clomiphene treatment

Posted August 12, 2013

What ICD-9 codes are recommended and in what sequence for a patient with insurance coverage for treatment of infertility whose insurance is being billed for a limited ultrasound follicle check/labs after taking clomiphene with the intention of intrauterine insemination (IUI)?
 

Image Documentation for Ultrasound Follicle Checks

Posted June 3, 2013

During ultrasound for follicle checks, does an image need to be saved to a chart?  ACOG and CPT state that an image needs to be in the patient’s chart, but my provider doesn’t do this.  Are there different documentation and image requirements for this type of service?

Coding for single-gene defects

Posted March 18, 2013

Our experience is that many carriers cover PGD for single-gene defects under the medical benefit, even when the patient lacks IVF coverage. In patients who are fertile, but are using the PGD as a way to avoid the conception of an affected child, is there a way to diagnostically code the IVF cycle that transmits that information to the third-party payer?

Ovulation management fee for ovulation induction

Posted January 28, 2013

For those patients undergoing ovulation induction, our practice is interested an ovulation management fee per treatment cycle.  This fee is generated from the physician's review of each monitoring which may include ultrasound and blood tests, as well as designating any changes to the patient's plan for subsequent cycles.  We use CPT code 99368, and we put this charge through at the end of the patient’s cycle, typically on the same date as her IUI.  We are not being paid by Health Partners for this charge due to a bundling error, do you have any suggestions?

Billing for 3-D Sonography

Posted April 5, 2012

How should I bill for 3-D sonography?

Reimbursement code for frozen embryo transport

Posted March 19, 2012

What is the code for frozen embryo transport?

Adenomyoma of uterine wall excision with repair

Posted October 25, 2011

I have a patient with an adenomyoma of the uterine wall that requires surgical excision and uterine repair. This will be a laparotomy and I don’t see an appropriate code.

Sperm Wash for IUI

Posted December 3, 2009

When billing a sperm wash, 58323, to an insurance company we are lucky to receive $10-$20 which is just ridiculous. Does the sperm wash code cover the semen analysis and morphology, or can we bill separately under the male for these services? We bill the sperm wash under the female.

Tompkins Metroplasty

Posted June 16, 2009

Is there a code for Tompkins Metroplasty? Our physician performed this procedure recently, and we are unable to determine the appropriate code to file our claim.

2008 Laparoscopic Total Hysterectomy

Posted June 16, 2009

New CPT Codes for 2008 Laparoscopic Total Hysterectomy

Ovarian Drilling

Posted June 16, 2009

Is there a CPT Code for "Ovarian Drilling"?

Intrauterine Inseminations Performed by Nurses

Posted June 16, 2009

At our center, the intrauterine inseminations are performed by our nurses. At the time of the insemination our nurse assesses the patients for any symptoms, reviews an instruction sheet that educates the patient about the symptoms of ovarian hyperstimulation, tells the patient when to come in for the pregnancy test, and reviews any additional physician instructions. In addition to all the standard charges for the insemination and sperm prep, can we also bill the evaluation management code 99211 with a modifier (-25)?

Perform IUIs

Posted June 16, 2009

Our physician currently does all of his own IUIs. We have recently hired an R.N. who has performed IUIs. We are thinking of having her help with our busy cycle months. Can we bill an insurance company for an IUI performed by a nurse? Does the physician have to be present in the office and sign off on office notes? Are there any legal concerns with malpractice in having the nurse perform these services instead of the physician?

Intrauterine Insemination (IUI)

Posted June 16, 2009

Does the code for intrauterine insemination (IUI) (58322) include the office visit (E/M) for that day, or is that only for the actual procedure?

Therapeutic Donor Insemination for an Unmarried Female

Posted June 16, 2009

How do I code for therapeutic donor insemination for an unmarried female with no known fertility issues except no partner?

Patient Undergoing Artificial Insemination Purely

Posted June 16, 2009

What is the proper ICD-9 code to use for a patient undergoing artificial insemination purely for sex preselection?

An IUI Cycle

Posted June 16, 2009

We have a couple who are doing an IUI cycle. The husband is expected to be out of town on the day of the insemination, so we've had him come to our office so we can collect and cryopreserve the specimen. We also have to wash the specimen. I know the CPT codes: 89261 and 89259. What would be the best ICD-9 code to use in this situation?

USG Guidance of Embryo Transfer

Posted June 15, 2009

How do you code for Ultrasonography performed at the time of an embryo transfer? 

Introduction of Saline or Contrast

Posted June 15, 2009

If the answer is “if you perform the injection of contrast for an HSG at a radiology facility, you can report 58340: introduction of saline or contrast.” Should you not also bill 76831-26?

Hysterosalpingogram or Saline Hysterosonogram

Posted June 15, 2009

How do you code for a hysterosalpingogram or saline hysterosonogram?

Check for Follicles During Ovulation Induction

Posted June 15, 2009

What code should be used for a vaginal probe ultrasound done to check for follicles during ovulation induction -- 76857 or 76830-52? We are planning to open an IVF lab that is not contracted with insurance companies. The stimulation portion of the IVF cycle will be rendered by the physician’s practice which is contracted with insurance. The retrieval, transfer, embryo culture, etc., will be provided by the IVF lab, those services will be paid by the patient, and the patient will seek reimbursement from her insurance if she has coverage. The same physician that monitors the ovulation induction portion of the cycle will be doing the retrievals and transfers in the lab. Is it appropriate to bill the physician's fees for the retrieval (58970) and transfer (58974) under the IVF lab since that is where the service will be provided? Or should those fees be billed under the physician's practice?

Abdominal Paracenteses on Patients

Posted June 15, 2009

We do a lot of abdominal paracenteses on patients at our facility. The first paracentesis that is done on the patient we use 49080 and subsequent paracentesis should be coded 49081. The only thing that I'm able to find is in the Coders' Desk Reference concerning the coding of paracentesis. Are you aware of anything out there in the coding world that gives more information concerning this issue?

PGD Performed Due to a Genetic Disorder

Posted June 15, 2009

What would be the diagnosis code for PGD performed due to a genetic disorder (fragile x syndrome)? Would I use 628.8 for female infertility -- although this is really not correct?

Lab Portion of PGD

Posted June 15, 2009

Have any new codes been introduced for the lab portion of preimplantation genetic diagnosis (PGD)?

Correct CPT Code for PGD

Posted June 15, 2009

I am trying to identify the correct CPT code for preimplantation genetic diagnosis (PGD). Could you help?

Do PGD

Posted June 15, 2009

Our clinic is just starting to do PGD. We currently are flying in an embryologist from out of state to do this procedure for our patients. I have a patient who might have insurance benefits for PGD. Since we are not physically doing the procedure, but are flying in/out the embryologist who prepares the slides, then completes the procedure in his/her own lab, can we bill the insurance? For self-pay patients, we currently collect a one-lump fee, and out of that fee, we pay air fare, hotel, eating expenses, and the embryologist’s professional charges and laboratory charges. We haven’t had to deal with a patient and insurance for this type of service before.

Screening Tests Performed

Posted June 15, 2009

What is the correct ICD-9-CM Coding for screening tests performed by physicians treating infertility patients?

Laparoscopic Lysis of Omental Adhesions

Posted June 15, 2009

Is there a code for laparoscopic lysis of omental adhesions? Our coder showed me enterolysis, tubolysis, ovariolysis, etc., but I didn't think any of those were right.

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