Oocyte Denudation
- Is there is a separate code for denudation of oocytes? and
- If denuding oocytes is bundled into another code for either IVF or ICSI, please explain. Assisted hatching has its separate code, and it is a much simpler procedure. Assisted hatching is making the shell (zona pellucida) of the embryo thinner by several different micro-techniques. Most common method is using laser. If the lab does not have a laser, then an acidic solution is used to carefully dissolve the zona. Assisted hatching is a different procedure from denudation of oocytes and is done for different reason. When denuding (stripping) the oocytes is for ICSI: One must immerse the eggs in hyaluronidase for about a minute, no less, no more. Timing is important. If the egg is immersed in the hyaluronidase too little time, the cumulus cell will not come off and stick to the eggs. It is impossible to pass an ICSI needle through the cumulus cells into the egg. In other words, the egg must be almost naked with no cumulus cells attached to it. Immersing the egg in hyaluronidase too long will adversely affect the egg. (Naturally, sperm produces that enzyme hyaluronidase to break apart the cumulus cells that surround the egg. But when doing ICSI, nothing is natural here.) The bulk of the cumulus cells will come off after that one minute of "digestion" by the hyaluronidase enzyme. But usually there is still a layer or two of cumulus cells densely adherent to the egg surface. After that one minute of hyaluronidase, one uses a series of pipette tips with decreasing size, from 175um, to 150 um and 135 um internal diameter to "squeeze" the eggs through the pipette, i.e. to force the remaining cumulus cells to fall off the surface of the oocytes, hence the name "stripping". When denuding oocytes is done for conventional IVF: Denuding / stripping for conventional IVF is done the day after the oocytes are inseminated with sperm. The sperm will have done most of the job of removing the bulk of the cumulus cells, but we still need to pass the eggs through a series of pipette tips with decreasing size, from 175um, 150um to 135 um diameter, to completely remove the cumulus off the surface of the eggs. For IVF, we need to see through the eggs under the microscope after conventional IVF to confirm fertilization. One looks for whether there are exactly two pronuclei, one from the egg and one from the sperm. Two pronuclei is a normally fertilized egg. Sometimes you see three or more pronuclei, those eggs must be discarded immediately. An unfertilized egg has no pronucleus. Denudation (or removal of all the cumulus cells around the oocyte) is a necessary procedure before the oocyte can be ICSI. Denudation (or removal of all the cumulus cells around a fertilized egg when conventional IVF is done) is a necessary procedure before the oocyte can be examined under the microscope to check whether it was fertilized normally, with two pronuclei, NOT fertilized, or abnormally fertilized like having three or more pronuclei. After reading the Correct Coding for Lab Procedures paper, we remain unsure about this billing. Your review and reply will be greatly appreciated.
Login now to view this Coding information. Coding Resources are available to ASRM Members only.
If you are not an ASRM member and would like to be, visit the Membership Tab above.
Coding Q&A
View more Coding Q&A in this category
Appropriate Use of Modifier -25
Is Modifier -25 appropriate in the monitoring cycle when an ultrasound
How to bill for an FET
Is there a new update to the 89272 code that allows its use without
Billing for assisted hatching at biopsy and transfer
We would also like to know if you can bill assisted hatching with biopsy and then assisted hatching again during the transfer cycle.
Sperm wash/IUI
Is CPT code 89260 is correct to use for our sperm wash/IUI procedure?Coding Corner
Coding Corner is segmented into the following sections. Click an image below to view questions and answers in that section.
More Resources
ASRM Academy on the Go
ASRM MAC Tool 2021
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.
Practice Guidance
EMR Shared Phrases/Template Library
This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.
ASRM Practice Documents
These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.
ASRM Ethics Opinions
Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Practice Guidance
Coding Corner Q & A
The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.
Practice Guidance
COVID-19 Resources
A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.
Patient Resources
ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.
Topic Resources
View more on the topic of in vitro fertilization (IVF)
Fertility Care Gets Important Win in California
ASRM celebrates California's SB 729, expanding IVF coverage for same-sex couples and singles, advancing equitable fertility care access.
View the Press Release
ASRM Today: Equity, Access, and Innovation, Episode Five: Policy Matters
This episode covers ballot measures on reproductive rights, ASRM advocacy efforts, and Vot-ER’s push for civic engagement among healthcare workers ahead of elections. Listen to the Episode
Nation’s Leading Professional Group for Fertility Care Professionals Calls for Passage of Right to IVF Act
ASRM applauds Majority Leader Schumer’s decision to seek reconsideration of the Right to IVF Act.
View the Press Release
ASRM Today: Equity, Access, and Innovation, Episode Three: Innovation
Explore innovation in reproductive health with ASRM Today. Discover how AI, robotics, and new technologies are transforming fertility care and improving patient outcomes. Listen to the Episode
Fertility and Sterility On Air - Live from ESHRE 2024: Part 1
Discover the impact of embryo expansion post-biopsy and freezing time standardization on live births in this episode from ESHRE 2024. Listen to the Episode
Fertility and Sterility On Air - Live from ESHRE 2024: Part 2
Explore fresh embryo transfers, progesterone elevation, and day-seven embryo utility from experts at ESHRE 2024. Cutting-edge fertility insights await! Listen to the Episode
Fertility and Sterility On Air - ANZSREI 2024 Journal Club Global: "Should Unexplained infertility Go Straight to IVF?"
Join "Fertility and Sterility On Air" for insights from the ANXSREI conference on unexplained infertility, IVF, and expert debates. Listen now at ASRM.org. Listen to the Episode
The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024)
PGT-A use in the U.S. is rising, but its value as a routine IVF screening test is unclear, with mixed results from various studies. View the Committee Opinion
Trump Calls for IVF Coverage, California Legislature Sends IVF Mandate Bill to Governor
The California General Assembly approved a bill mandating most private health insurance plans to provide coverage for In Vitro Fertilization (IVF).
View the Press Release
Journal Club Global from ANZSREI 2024: Debate Unexplained infertility; Straight to IVF?
ANZSREI 2024 debate: Should unexplained infertility go straight to IVF? Experts discuss pros, cons, and alternative treatments. No clear consensus reached. View the Video
Get Vot-ER Ready This National Patient Advocacy Day!
Celebrate National Patient Advocacy Day by boosting civic engagement! Order your free Vot-ER badge to help patients register to vote and promote healthy communities.
View the Press Release
Who to bill for gestational carrier services if intended parents have insurance?
I wanted to inquire about guidelines for billing services to a surrogate’s insurance company if intended parents purchased the insurance coverage. View the Answer
Performing MD is not the Doctor of Record
Currently we are billing the performing provider as the service provider and the Doctor of Record as the billing provider. View the Answer
ASRM marks World IVF Day by doing what we do best – advocating for access to reproductive health care by calling for a House floor vote on the Right to IVF Act
ASRM observed World IVF Day, the day marking the birth of the world’s first IVF baby in 1978, by continuing its advocacy for improvements in IVF policy.
View the Press Release
Journal Club Global: Oral Progestin For Ovulation Suppression During IVF
Live broadcast from the 2024 Midwest Reproductive SymposiumInternational in Chicago, IL View the Video
Order your FREE Vot-ER badge to encourage patients and colleagues to vote!
ASRM) is pleased to announce our partnership with Vot-ER, a grassroots organization dedicated to driving civic engagement among healthcare professionals.
View the Press Release
Fertility and Sterility On Air - Seminal Article: Ernest Ng and Zhi Chen
June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders. Listen to the Episode
ASRM Responds to Senate Vote on IVF Bill
ASRM is disappointed that a filibuster prevented the passage of the Right to IVF Act.
View the Press Release
ASRM Calls for Passage of Family Building Bill
It would increase access to IVF treatments for all Americans, including active-duty service members, veterans, and federal employees.
View the Press Release
Fertility and Sterility On Air - TOC: May 2024
Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A. Listen to the Episode
ASRM publishes IVF one-pagers for media use
The documents lay out the clinical IVF process, summarize oversight of IVF in the U.S., and explain how lawmakers can support access to IVF.
View the Press Release
Billing for assisted hatching at biopsy and transfer
We would also like to know if you can bill assisted hatching with biopsy and then assisted hatching again during the transfer cycle. View the Answer
ASRM Reacts to Cruz/Britt OPED
We are pleased to see Senators Cruz and Britt express their interest in protecting access to IVF.
View the Press Release
Fertility and Sterility On Air - Unplugged: April 2024
Topics include: IVF in film, a rat model of fallopian tube torsion, comparing letrozole regimens for PCOS, and a review of chronic endometritis. Listen to the Episode
ASRM Files Amicus Brief in Texas Embryo Case
ASRM has filed an amicus curiae (friend of the court) brief in the case of Antoun v Antoun, which is pending before the Texas Supreme Court.
View the Press Release
Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)
Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles. View the Committee Document
Survey shows strong support for increased access to fertility treatments
A new public opinion poll reveals strong support for improved access to In Vitro Fertilization (IVF).
View the Press Release
National Infertility Awareness Week 2024: Leave Your Mark
Next week is National Infertility Awareness Week, a federally recognized health observance founded to increase awareness of infertility.
View the Press Release
ASRM Today: ASRM Policy Matters: Post-Alabama IVF decision advocacy roundup with Jessie Losch
Jessie Losch, ASRM Government Affairs Manager, updates ASRM Today on the advocacy efforts underway post the Alabama Supreme Court decision. Listen to the Episode
IVF-assisted pregnancies constitute 2.5% of all births in 2022
In 2022, the number of babies born from IVF increased from 89,208 in 2021 to 91,771 in 2022. This means that 2.5% of births in the US are a result of ART.
View the Press Release
Alabama Supreme Court Rules Frozen Embryos are “Unborn Children” and admonishes IVF’s “Wild West” treatment
Legally Speaking™ on presenting facts and reflecting on the impact and potential implications of legal developments in ART. View the Column
Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023)
Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. View the guideline
Billing IVF lab work
We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
Journal Club Global: IVM in Clinical Practice: An Idea Whose Time Has Come?
In vitro maturation (IVM) has the potential to make IVF cheaper, safer, and more widely accessible to patients with infertility. View the Video
Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline (2018)
Mild-stimulation protocols with in vitro fertilization (IVF) generally aim to use less medication than conventional IVF. View the Guideline
IVF cycle management and facility fees, an overview
How should IVF Cycle Management be coded? View the Answer
Limited ultrasound performed by RN
Would it be appropriate to bill a 99211 when an RN is doing a limited ultrasound and documenting findings during an IUI or IVF treatment cycle? View the Answer
CPT 89253 and 89254 for Assisted hatching
Can I bill CPT codes 89253 and 89254 together? If yes, do I need a modifier on any of the codes? View the Answer
Journal Club Global - What is the optimal number of oocytes to reach a live-birth following IVF?
The optimal number of oocytes necessary to expect a live birth following in vitro fertilization remains unclear. View the Video
Patient Education
What is the correct way to bill for the patient education sessions performed by registered nurses to individual patients prior to their IVF cycle? View the Answer
Pregnancy Ultrasound
Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART. View the Answer
IVF Consent Counseling
When a patient is scheduled to undergo IVF and the provider schedules the patient for a 30-minute consultation is this visit billable? View the Answer
Lab Case Rates
What ICD-10 codes apply to case rates? View the Answer
In Vitro Maturation
Have CPT codes been established for maturation in vitro? View the Answer
IUI or IVF
Should other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used for an IUI or an IVF cycle View the Answer
IV Fluids During Egg Retrieval
Is it appropriate to bill the insurance company for CPT 96360, Under Hydration Infusion when being used in conjunction with IVF retrieval? View the Answer
IVF Billing Forms
I am seeking information on IVF insurance billing guidelines. View the Answer
IVF Billing Globally
Am I correct in assuming that it is duplicate billing for both the ambulatory center and embryology laboratory to bill globally? View the Answer
IVF Billing of Professional Charges
Are we allowed to bill professional charges under the physician for the embryologist who performs the IVF laboratory services? View the Answer
IVF Case Rates
What ICD-10 codes apply to case rates? View the Answer
Oocyte Denudation
Is there is a separate code for denudation of oocytes? View the Answer
Ovulation Induction Monitoring for IUI
We would like to clarify the correct ICD 10 diagnosis code for monitoring of an IUI cycle. View the Answer
Endometrial Biopsy/Scratch
What CPT code should be used for a “scratch test”? View the Answer
Endometriosis and Infertility
For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
Follicle Monitoring For Diminished Ovarian Reserve
If a patient has decreased ovarian reserve (ICD-10 E28.8) and patient is undergoing follicle tracking to undergo either an IUI cycle or IVF cycle... View the Answer
Global Billing Vs Billing Under Provider
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
Donor Embryos
Could you give guidance for the correct ICD-10 code(s) to use when a patient is doing an Anonymous Donor Embryo Transfer cycle? View the Answer
Egg Culture and Fertilization
We are billing for the technical component of 89250 and would like to also bill a professional component of the 89250. View the Answer
Egg Culture and Fertilization: Same Gender
A same-sex male couple requested half their donor eggs be fertilized with sperm from male #1 and the other half fertilized from male #2. View the Answer
Journal Club Global: Natural versus Programmed FET Cycles
A significant portion of IVF cycles now utilize frozen embryo transfer.
View the Video
Role of assisted hatching in in vitro fertilization: a guideline (2022)
There is moderate evidence that assisted hatching does not significantly improve live birth rates in fresh assisted reproductive technology cycles View the Committee Opinion
Journal Club Global - Best Practices of High Performing ART Clinics
This Fertility and Sterility Journal Club Global discusses February’s seminal article, “Common practices among consistently high-performing in vitro fertilization programs in the United States: a 10 year update.” View the Video
Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)
ASRM's guidelines for the limits on the number of embryos to be transferred during IVF cycles have been further refined ... View the Committee Opinion
Journal Club Global Live from India - Adjuvants in IVF and IVF Add-Ons for the Endometrium
Many adjuvants have been utilized by IVF centers to improve their success rates. View the Video
Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline (2021)
A review of success rates, factors that may impact success rates, and outcomes. View the Committee Opinion
Development of an emergency plan for in vitro fertilization programs: a committee opinion (2021)
All IVF programs and clinics should have a plan to protect fresh and cryopreserved human specimens (embryos, oocytes, sperm). View the Committee Opinion
In vitro maturation: a committee opinion (2021)
The results of in vitro maturation (IVM) investigations suggest the potential for wider clinical application. View the Committee Opinion
Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)
The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. View the Committee Opinion
Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion (2018)
The purposes of this document is to review the literature regarding the clinical application of blastocyst transfer. View the Committee Opinion
The role of immunotherapy in in vitro fertilization: a guideline (2018)
Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation failure. View the Committee Opinion
Performing the embryo transfer: a guideline (2017)
A systematic review of the literature was conducted which examined each of the major steps of embryo transfer. Recommendations made for improving pregnancy rates are based on interventions demonstrated to be either beneficial or not beneficial. (Fertil Steril® 2017;107:882–96. ©2017 by American Society for Reproductive Medicine.) View the Committee Guideline
Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
What support for IVF looks like
Bipartisan support for IVF, that is responsible for the birth of over 2% of all babies born in the USA each year, will ensure that families continue to grow. View the advocacy resource
It takes more than one
Why IVF patients often need multiple embryos to have a baby View the advocacy resource
Oversight of IVF in the US
In the US, medical care is regulated by a complex and comprehensive network of federal and state regulations and professional oversight. View the advocacy resource
In Vitro Maturation Special Interest Group (IVMSIG)
IVMSIG strives to define the best strategies to optimize IVM outcomes. Learn more about IVMSIG
Advocacy Resources
ASRM has prepared resources to help explain and advocate for reproductive rights and the continuation of in vitro fertilization and other fertility treatments. View the advocacy resourcesTopic Resources
View more on the topic of intracytoplasmic sperm injection (ICSI)
Codes for Embryo Biopsy
When doing a preimplantation genetic test (PGT) biopsy, can you bill for each day a biopsy is performed or can you only bill once for the cycle? View the Answer
Fertility and Sterility On Air - Live from ESHRE 2024: Part 2
Explore fresh embryo transfers, progesterone elevation, and day-seven embryo utility from experts at ESHRE 2024. Cutting-edge fertility insights await! Listen to the Episode
Fertility and Sterility On Air - TOC: June 2024
Covering articles on embryo transfer, PIEZO-ICSI, pregnancy outcomes, oocyte maturity, estradiol levels, and ovarian carcinoma and more! Listen to the Episode
Fertility and Sterility On Air - TOC: May 2024
Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A. Listen to the Episode
Fertility and Sterility On Air - TOC: April 2024
Topics this month include the use of ICSI, fertility treatments among reproductive-aged women after cancer, and more. Listen to the Episode
ICSI and Embryo Biopsy
How to bill for ICSI or embryo biopsies that occur in different days? View the Answer
Oocyte Denudation
Is there is a separate code for denudation of oocytes? View the Answer
Denudation of Oocytes
Is there is a separate code for denudation of oocytes? And if denuding oocytes is bundled into another code for either IVF or ICSI, please explain. View the Answer
Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion (2020)
Intracytoplasmic sperm injection is frequently used in combination with assisted reproductive technologies. View the Committee DocumentTopic Resources
View more on the topic of oocytes (eggs)
Oocyte cryopreservation
We code 89337 (cryopreservation of oocytes) for the entire oocyte preservation cycle, including monitoring visits. View the Answer
Reimbursement for cost of donor egg
My wife and I are going through a fertility treatment process, and we have purchased a donor egg out-of-pocket from a donor bank. View the Answer
Journal Club Global: IVM in Clinical Practice: An Idea Whose Time Has Come?
In vitro maturation (IVM) has the potential to make IVF cheaper, safer, and more widely accessible to patients with infertility. View the Video
Does the number of eggs being frozen matter?
There is currently only one CPT code for the cryopreservation of mature oocytes and embryos. View the Answer
Journal Club Global - What is the optimal number of oocytes to reach a live-birth following IVF?
The optimal number of oocytes necessary to expect a live birth following in vitro fertilization remains unclear. View the Video
Reproductive Tissue Storage
What are the CPT codes for the Storage of Reproductive Cells/Tissues? View the Answer
Oocyte Denudation
Is there is a separate code for denudation of oocytes? View the Answer
Oocyte Preservation Consult
Our center performs oocyte preservation procedures for women looking to preserve their fertility. View the Answer
Embryo Culture Less Than And More Than Four Days
When coding 89250 culture of oocytes/embryo <4 days, should that code be submitted to the insurance company for each of the days? View the Answer
Gamete Thawing/Warming
Can patients be charged for each vial/straw of reproductive gametes or tissues thawed? View the Answer
Donor Screening
Is there a specific CPT code used for Donor Physical Exams or would a practice just bill using the appropriate E&M Code? View the Answer
Journal Club Global: Should everyone freeze oocytes by age 33?
Oocyte cryopreservation is one of the fastest growing areas of reproductive medicine. View the Video
A review of best practices of rapid-cooling vitrification for oocytes and embryos: a committee opinion (2021)
The focus of this paper is to review best practices for rapid-cooling cryopreservation of oocytes and embryos. View the Committee Opinion
