Coding Corner


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Blood draw only--how to code?

Posted March 10, 2015

If a patient comes in only for a blood draw (venipuncture) and is seen only by the lab technician (not an MD, PA, or NP), may we bill for a (minimal) office visit?

Limited follow-up follicular transvaginal ultrasound

Posted January 30, 2015

What is the appropriate code to use for a limited follow-up follicular transvaginal ultrasound? There is no established code for this. Should a 52 modifier be used if all the complete ultrasound measurements are not taken? What about a limited follow up transvaginal ultrasound? 

Billing for embryo culture after freezing

Posted December 12, 2014

 Is it allowable to bill 89250 for the culture of embryos after thaw for a frozen embryo transfer (FET) cycle? Is there a certain time that the embryos must be in culture? The CPT code says <4 days.

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?

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 for physician review of abnormal test results

Posted February 10, 2014

Please recommend a CPT code to fit this service if available: 

This charge is generated from the physician's review of abnormal testing or lab results.  The physician indicates any changes to the treatment plan or authorizes proceeding with treatment based on the outcome of that testing. This allows the patient to move forward with treatment without the cost of an additional consult with the physician. Usual physician time is 5-15 minutes and the phone call to the patient is done by a nurse.

Coding for the infertility testing phase

Posted February 10, 2014

We have been using a testing diagnosis code V26.21 and are being told by insurance companies that this code is invalid. Do you have other diagnosis codes that are used during the testing phase?

Coding for a mock embryo transfer

Posted February 10, 2014

Can you advise the proper coding process for a trail transfer?  The limited ultrasound code 76857 is the only code that I could come up with for the procedure. 

ICD-9 code for recurrent implantation failure

Posted February 10, 2014

What is the appropriate ICD-9 code for recurrent implantation failure? The provider performed a diagnostic hysteroscopy for a patient with recurrent implantation failure.

Billing for Pre-IVF Consultation for Consents and Risk Discussion

Posted January 3, 2014

When a patient is scheduled to undergo IVF and the provider schedules the patient for a 30-minute consultation to sign consents and discuss risks associated with in vitro fertilization, ovarian stimulation, and oocyte retrieval, is this visit billable, or should it be included in the global charge for the IVF?

Code for Monitoring Patients During Ovulation Induction for IVF and IUI

Posted January 3, 2014

Is there is CPT code that reflects the monitoring of IUI and IVF patients? 

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?

What is the ICD-9 code for oligo-ovulation

Posted December 17, 2013

What is the ICD-9 code for oligo-ovulation? If a patient is being seen for follicle tracking for HMG/TIC cycle with oligo-ovulation, is the ICD-9 code 628.0 (Infertility Anovulation)?

Can I use diagnosis codes for ovarian dysfunction for IUI or IVF

Posted December 17, 2013

Our practice would like some guidelines on whether other ovarian dysfunction (diagnosis code 256.8) or unspecified ovarian dysfunction (diagnosis code 256.9) can be used as the sole diagnosis code for an IUI or an IVF cycle.  Are the documentation requirements any different than just 628.9? 

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?

Appropriate coding for nursing staff interaction and cycle management conferences during ovulation-induction cycles

Posted December 17, 2013

We are considering the use of CPT code 99211 for encounters during cycle management as part of ovulation induction. Nursing staff meets with the patient after ultrasounds are performed and blood work is drawn. Ultrasound results are discussed with the patient at that time. All results are discussed with the physician who is in the office. The nursing staff contacts the patient later in the afternoon after the blood work results are complete. Is this an appropriate use of this E+M code?

Can we submit team-management CPT codes per patient for daily cycle-management conferences that determine ongoing treatment during the cycle? Do those codes require more significant amounts of time spent than the few minutes per patient that are spent? 

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.

Billing for Oocyte Retrieval-Donor Egg

Posted December 3, 2013

  1. What bill form is used for IVF donor egg retrieval – a UB and a 1500?
    • Is the donor egg retrieval included on the bill to insurance with the first IVF treatment for the recipient?
  2. How do you identify the donor egg retrieval on the recipient’s claim?
    • Is there a specific CPT/HCPC that identifies the service as “anonymous donor”?

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)?

Does an REI have to code the initial consult as infertility prior to making the diagnosis?

Posted July 16, 2013

Often, a patient comes to the office on her own or is referred for a consultation by her OB/GYN to the REI office for "infertility" prior to any evaluation.  Is it necessary to use an infertility code (ICD 628.XX) for this visit?  What if she has irregular menses, suspected PCOS, galactorrhea, hypothyroidism, ovulatory dysfunction, etc.?  We are getting more than a few denials, or patients who are canceling their consult because they have no "infertility coverage", before a proper diagnosis is made.

To me this is analogous to someone going to the emergency room complaining of chest pain and saying they are having a heart attack.  When it turns out to be heartburn, the ER physicians do not bill for myocardial infarction.

Can a Skype interview be coded as a new patient visit?

Posted July 15, 2013

For international patients, where a visit is conducted via Skype, is it possible to code for a new patient visit based on time in that the physician and patient are engaged in a “face-to-face” encounter and more than 50% of the visit consists of counseling?

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?

Coding education and teaching for injectable medications

Posted December 10, 2012

Our clinic is having difficulty with the codes we are using for education and injection classes.  Typically, we will do the medication outline (letrozole, clomiphene) over the phone with one of our nursing staff members, and the injection class in the office with a nurse. 
Currently, we are coding the classes as:

  • 98968 - Medication outline
  • 98960 – Injection class

Is there a modifier that should be used if these two classes are done in the same visit?

Correct code for pregnancy test after stimulation

Posted November 29, 2012

What is the best code to use for a pregnancy test (beta HCG) after treatment for infertility by IUI with or without clomiphene or injectable gonadotropins? Is it correct to code this pregnancy check under infertility diagnosis or should it be coded under another diagnosis such as unconfirmed pregnancy or other non-infertility diagnosis?

Is there a CPT code for mock embryo transfer prior to IVF?

Posted November 20, 2012

My doctor wants to do a mock transfer prior to an actual IVF procedure using a frozen donor oocyte. My insurance is willing to pay for the procedure. However, I do not have the CPT to file with my insurance because my doctor's office billing department said that there is no CPT code for such a procedure because it is done in preparation for a donor egg bank cycle. Is this correct? Is there a CPT code for this procedure?

Coding for Patient Visits to Discuss Fertility Options without Known or Suspected Infertility

Posted July 23, 2012

We are seeing a lot of patients coming in to just discuss the fertility options available to them.  They are not necessarily infertile.  We have been using ICD9 code V26.89.  Do you recommend that we utilize any other ICD 9 codes?  If so, which ones?

Fertility preservation reimbursement

Posted May 25, 2012

Our center performs oocyte preservation procedures for women looking to preserve their fertility.  When they come in for their initial consultation or follow-up visits, we bill with diagnosis code V26.49 (other procreative management, counseling and advice) or sometimes we use V65.49 (other specified counseling).  Recently, BCBS started denying anything that we bill with these two codes because they consider them “routine”.  Do you know of any other ICD-9 we can use when the patient comes in for consults/follow ups?

Is there a billing tip for getting reimbursed for a sac check at the end of an IVF cycle?

Posted May 25, 2012

Our practice does routine ultrasounds (sac check- 76817) at the end of an in vitro fertilization cycle and bill with a diagnosis code V23.85, pregnancy resulting from assisted reproductive technology. Recently, we are receiving insurance denials. No other diagnosis codes can be used, i.e., maternal complications, etc., in most of these cases. The sac check is done routinely before we transfer the patient to their OB/GYN. Do you have any billing tips for the follow-up sac checks?

Updates to CPT code set for 2012

Posted May 21, 2012

The Current Procedural Terminology code set (4th Edition) for 2012 has several updates of interest to practitioners in the field of reproductive endocrinology and infertility. HIPAA requirements dictate that insurers must accept new codes beginning January 1, 2012, although April 1st is commonly observed as the date when new CPT changes go into effect.

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?

Diagnosis code for follicle ultrasound with FET

Posted October 25, 2011

What is the correct diagnosis code to use on the follicle ultrasound (76857) for a patient who is undergoing frozen embryo transfer (FET)? The documentation does not state Infertility.

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.

Transgender injections post surgery

Posted October 25, 2011

I have a question about a patient who is a transgender male to female.  The patient has had sexual reassignment surgery; however, she comes in for medroxyprogesterone acetate (Provera) and spironolactone medication refills as well as injections of estradiol valerate (Delestrogen).  We initially had coded it as 302.50, and, of course, insurance denied it. The patient disputed the denial because she states that she is legally a female now.  An addendum was added stating that the patient suffers from intersexuality, endocrine disorder.  At that time, per my coding manager, we changed the coding to 259.9, 302.50.  We are questioning if this is the correct way of the order of diagnoses or if you have any other thoughts on how this should be coded.

New, Expanded, And Revised ICD-9-CM Codes, Effective October 1, 2011

Posted September 1, 2011

The following are new, expanded, and revised ICD-9-CM codes that are of interest to practitioners in the field of Reproductive Medicine. These codes will take effect October 1, 2011. HIPAA requires providers to use the medical code set that is valid at the time the service is provided. Therefore, physicians must cease using discontinued codes for services after the new codes become effective October 1, 2011.

More than one diagnosis code

Posted May 18, 2010

Several years ago, I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of 614.1 (hydrosalpinx). Yet, for the office-based care of a patient with say, PCOS and infertility, both diagnoses were required for correct coding. Do you agree with either or both of these coding approaches, which seem inconsistent?

Insurance companies deny the embryo thaw 89352

Posted May 18, 2010

I am having insurance companies deny the embryo thaw 89352 as included in another procedure. How do I send an appeal to show it is not included in any other procedure?  We usually bill 89352,89255,58974,76705 and 89253 for assisted hatching, when done.  I do not find any where that these are bundled procedures. Please advise.

List of RVUs for laboratory procedures

Posted May 18, 2010

Is there a list of RVUs for embryology and andrology laboratory procedures, and if so, where can it be found?

Billing for color flow Doppler

Posted May 18, 2010

I often use color flow Doppler ultrasound to identify the presence of blood flow.  For instance, I use Doppler to evaluate ovarian blood flow in women with abdominal pain, to look for a feeding vessel in women with a possible uterine polyp, to evaluate the presence of blood flow in an ovarian cyst, and sometimes to better define the ovarian borders.  Can I bill for the use of color flow Doppler to identify the presence of blood flow?  If so, what codes should we use?

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.

Ovarian Cyst and Ultrasound

Posted December 3, 2009

When a patient has a cyst from a previous Clomid or gonadotropin cycle, is it appropriate to bill the insurance company for the ultrasound with a 620.2 diagnosis if the patient will take that cycle off? There is not a need to put a secondary diagnosis code of 628.9, is there?

Recurrent Pregnancy Loss Coding

Posted December 3, 2009

Our physicians have struggled with particular patients who have to pay for their infertility services (because as we all know, most insurance companies do not cover treatment of infertility) because the diagnosis is 628.9. There are very few patients who are not infertile but are actually RPL (629.81), and in their recurrent pregnancy loss work up, the only finding is progesterone deficiency. These patients will usually be prescribed Clomid to hopefully correct this deficiency and help a pregnancy last. With regard to the ovary checks and ultrasounds these patients have, what should their diagnosis code be -- 628.9 or 629.81? I am afraid if we bill it with a 629.81 to an insurance company and a policy pays on it and later requests records, we may get into trouble for insurance fraud. We know there are patients as well who have been diagnosed as 629.81 and have not been able to conceive again, and in these cases when Clomid is prescribed, we feel it is appropriate to bill with a 628.9 diagnosis code.  

New, Expanded & Revised ICD-9-CM Codes, Effective October 1, 2009

Posted December 3, 2009

Following are new, expanded, and revised ICD-9-CM codes that are of interest to ASRM members and taking effect October 1. HIPAA requires providers to use the medical code set that is valid at the time the service is provided. New fertility preservation counseling and procedure codes have been developed that recognize that more and more patients are living longer after a cancer diagnosis and yet, some types of cancer treatment can affect a person's ability to conceive a child or maintain a pregnancy. The American Society for Reproductive Medicine, in collaboration with ACOG, has developed codes for encounters to preserve fertility before and after cancer treatments.

Insurance Will Cover The Procedure

Posted September 29, 2009

What is the procedure code for IVF? I'm trying to find out if my insurance will cover the procedure.

Pelvic Sonography And Echography

Posted September 29, 2009

My infertility doctors bill the 76830 transvaginal ultrasound every time they perform an ultrasound even when they are monitoring the patient’s follicle. Should they be billing 76857, Ultrasound pelvic limited or follow up (e.g. for follicles). The doctor states that they not only look at the follicles but also the endometrium. Their report states:

Endometrial Thickness (mm) 10.0
Number of follicles <10 mm
Number of follicles >12mm
Total # of measured follicles
All measured follicles 

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?


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.

CPT Codes for Telephone Calls

Posted June 15, 2009

Can you please clarify the intent of the CPT codes for telephone calls? Specifically, I am interested in understanding when it would be appropriate to use the CPT codes 99371, 99372, and 99373. Most reproductive clinicians routinely coordinate medical management or have regular contact with their patients, either directly or indirectly by phone, multiple times during an ART or IUI/FSH cycle. Is it appropriate to bill for these calls in association with ren­dering daily test results (E2, ultrasounds, etc.), advising patients of daily gonadotropin dosages, answering routine questions and/or discussing future plans? Or, is it not appropriate to bill separately for these items as they are part of routine infertility care?

Telephone Consult

Posted June 15, 2009

Does a physician need to speak directly to a patient to code for a telephone consult (99371-99373) or can a physician give specific instructions to a staff member to relay to patients? Patients can be difficult to contact, and physicians have limited time during the day. For example, if a nurse relays information that a pregnancy test is negative and that the patient should start her BCP on Sunday, would this be appropriate to code as 99371?

Patient Education

Posted June 15, 2009

What is the correct way to bill and receive payment for the patient education sessions performed by registered nurses to individual patients prior to their IVF cycle? We typically spend at least one hour with each patient and partner discussing instructions and protocol for their ovulation induction.

Initial New Patient Consultation as Opposed to Being Referred by another physician

Posted June 15, 2009

If we have a patient who self-refers to our physician for an initial new patient consultation as opposed to being referred by another physician, how do we code for the consult? Also, when our physician brings the patient back into the office for a follow-up consultation to discuss diagnostic results and treatment recommendations, how do we code? Both of these consultations include approximately one hour of face-to-face time with the physician.

Recurrent Miscarriages

Posted June 15, 2009

Our reproductive endocrinologist sees patients for recurrent miscarriages. When he sees the patient for the first visit, is it appropriate to use the diagnosis codes V26.4 (procreative management) as a primary code and 629.9 as a secondary code?

Initial Visit for Infertility

Posted June 15, 2009

What code would be appropriate for an initial visit for infertility? Our practice is in a state where there is no mandated coverage for infertility. We are finding that many insurances will not cover if the word “infertility” is used.

Nurse Practitioner Seeing a Fertility Patient

Posted June 15, 2009

What code is used for a nurse practitioner seeing a fertility patient for the first time?

New Infertility Patient

Posted June 15, 2009

How soon can you bill as a new infertility patient? If a patient has not been seen since 2004 for infertility and is now returning for infertility in 2006, would they be considered a new patient? What is the time frame to bill again as a new patient?

ASC Bill Third-party Payors a Facility Fee

Posted June 15, 2009

If an IVF embryo extraction and transfer is performed at an ambulatory surgical center (ASC), can the ASC bill third-party payors a facility fee? Can they bill such a fee in addition to what the IVF physician and the embryology lab may bill?

Bill a Facility Fee

Posted June 15, 2009

Can a privately owned office facility dedicated to IVF services and embryology lab bill a facility fee to insurance companies?

Adhesion Lysis

Posted June 12, 2009

We have been struggling with 58660 lysis of adhesions and insurance reimbursement. Most insurance companies are denying this code when billed with another laparoscopy such as 58661 or 58662, etc., stating these codes are bundled. According to the AMA, in March of 2003, 58660 can be billed in addition to the primary procedure only if “dense/extensive adhesions are encountered that require effort beyond that ordinarily provided for the laparoscopic procedure.” What is a “normal” amount of adhesions, and is this based on a timing structure (i.e., how long it takes to lyse the adhesions)?

Evaluation & Management Service

Posted June 12, 2009

I saw a patient for consultation who had irregular uterine bleeding. After I evaluated her, I performed an endometrial biopsy. The insurance company denied the consultation and only reimbursed me for the endometrial biopsy. Shouldn’t I have been paid for both?

Coverage for Infertility

Posted June 12, 2009

As a gynecologist, all my patients are female. I have a patient with suspected male infertility. When I order a sperm test on the male partner it is routinely denied by her insurance. Our office has confirmed that she has coverage for infertility. How can I solve this problem?

Pre-IVF Testing

Posted June 12, 2009

Is there another code other than V26.21 or V26.29 for pre-IVF testing that insurance will NOT deny?


Posted June 12, 2009

My insurance company is bucking me on paying for frozen embryo transfer - they say because it is experimental.  I want to know if this is still considered experimental or if it is an FDA approved procedure.

Experimental in Nature

Posted June 12, 2009

We have received denials from insurance payers when billing CPT code 89251.  The denial indicates “experimental in nature, not FDA approved.”  I understand that CPT codes are not approved by FDA, but by the AMA.  Can you advise with appealing this denial?


Posted June 12, 2009

First Trimester Ultrasound Denials


Posted June 12, 2009

Excuse me, but I did that twice! Explain more about relative value units (RVU).

Retrograde Semen Analysis

Posted June 12, 2009

Our physicians do the retrograde semen analysis. What CPT/CPTs would you suggest we use?

Existing Semen Analysis

Posted June 12, 2009

There are two new codes and revisions were made to the existing semen analysis codes to clarify their intent. The word "complete" was deleted from code 89320 to clarify that it is for a basic semen analysis that includes analysis of ejaculate volume and sperm count, motility and differential. The word "sperm" was added to code 89321 to make it clear that this test is for the presence and motility of sperm.

Bill for the Semen Analysis

Posted June 12, 2009

We frequently perform Strict Criteria Morphology alone (without semen analysis). What would be the appropriate code for that test?

Female Infertility

Posted June 12, 2009

If a husband has had a vasectomy, does the sterilization code apply to the wife's visits?

Bill for the Diagnosis Part of Procreative Management

Posted June 12, 2009

I am trying to get some guidance on the correct way to bill for the diagnosis part of Procreative Management. I understand that when a patient is going through the diagnostic portion of determining the reason for infertility, you would use the appropriate ICD.9 code to indicate the reasons for the test. My question is: Once we have determined that the patient is infertile, and we want to go ahead with the IVF process, would it be appropriate (is it required) to use the V26.9 code as the primary diagnosis and the reason for the infertility as the second diagnosis? The second part of my question is do you have some guidance on what else would be considered procreative management?

Infertility and the Etiology

Posted June 12, 2009

Reproductive Endocrinology/Infertility sub-specialists often evaluate a couple for infertility and know that the etiology may result from abnormalities in either or both partners. Since you provide services to both the husband and the wife, it is suggested that you also code separately on both partners.

Ovarian Stimulation

Posted June 11, 2009

When our doctor does a paracentesis for a patient with ovarian stimulation, what would be the best CPT code to use? We are considering using 49080. Can this be used with 76942 when ultrasound guidance is used, or do we need to pick one or the other?

Controlled Ovarian Stimulation

Posted June 11, 2009

What is the code to use for COS (Controlled Ovarian Stimulation): managing the patients, dosing of HMG, etc.?

Sperm Aspiration

Posted June 11, 2009

I need a CPT code for microsurgical epididymal sperm aspiration. Could you help?

Mock/Trial Embryo Transfer

Posted June 11, 2009

I looked through the “Ob/Gyn Coding Manual” and have not found a code for a mock embryo transfer. How can I report this procedure?

Maturation In Vitro

Posted June 11, 2009

Have CPT codes been established for Maturation In Vitro? If so, what are they?

The CPT coding info for ART labs

Posted June 11, 2009

The CPT coding info for ART labs you provide is very useful. Do you have information on endocrine lab testing -- specifically, CPT codes and typical reimbursement from third-party payers? Also, how does reimbursement for diagnostic endocrine testing differ from endocrine monitoring for the treatment cycle? Are there other diagnostic andrology procedure codes and reimbursement for tests such as the cervical mucus penetration test, etc., that you did not list in the "correct coding for lab procedures during ART cycle" publication?

Coding for Cycle Management

Posted June 11, 2009

One of the problems we are having is coding for the management cycle. Coding for insurance companies for in vitro fertilization is still quite new to us. Can you help?

ART Laboratory procedures

Posted June 11, 2009

Where can I find a list of the new codes for ART Laboratory procedures?

Billing Lab Procedures for IVF

Posted May 29, 2009

I am seeking information on IVF insurance billing guidelines. When billing the lab procedures do you use a 1500 claim form only or in combination with the UB92? I am referring to: 58970, 58974, 89280, 89281, 89255, 89352, 89258, and 89253.

Diagnosis Code for Patient Undergoing ART

Posted May 29, 2009

Important new ICD-9 Diagnosis Codes for 2008 Patient Undergoing Assisted Reproductive Technology

Surrogate Carrier

Posted May 29, 2009

What is the appropriate ICD-9 code for a surrogate carrier? Can you make a recommendation?

Gestational Carrier Code

Posted May 29, 2009

If a woman requires a gestational carrier, how is the gestational carrier coded? She is truly not a surrogate, just gestational.

Bill Professional Charges Under Physician for Embryologist

Posted May 29, 2009

Are we allowed to bill professional charges under the physician for the embryologist who performs the IVF laboratory services (ICSI, hatching, cultures)?

Physician Professional Fee

Posted May 29, 2009

We have a hospital-based embryology lab that is headed by a physician. We are billing for the technical component of 89250 and would like to also bill a professional component of the 89250. We have not been able to support the professional billing of this code (89250). After extensive research, we cannot find anything definitive. It seems to me that there is sufficient physician involvement to generate a professional fee. This code does appear on at least one of our contracted payment schedules, but does not appear on the Medicare physician fee schedule.

Donor Sperm

Posted May 29, 2009

Is there a code that can be used for donor sperm?  

Insurance Coverage for Donor Egg Retrieval

Posted May 29, 2009

How do you submit billing when a patient has insurance coverage for donor egg retrieval? It also pays for medications (i.e., Antagon®, Repronex™, and Follistim® for the egg donor). What CPT codes should be used if an egg donor is used? 

Infertility Counselor Before Using Donor Gametes

Posted May 29, 2009

In accordance with ASRM practice guidelines, many REs require patients (and their spouses/partners) who are considering using donor gametes to see an infertility counselor first. Assuming the purpose of these consultations is to explore relevant psychosocial issues, rather than to evaluate "suitability" for treatment, how should they be coded by the infertility counselor? 

Embryo storage

Posted May 28, 2009

I am writing in regards to this question, because I am interpreting this as though a provider should NOT be billing 89258 for cryopreservation of embryo & storage of embryo. Am I interpreting this correct? Or can a provider bill storage under this code, just with an increase fee? I came across your website because a friend is having a difficult time getting her provider to bill embryo storage because they state this code is for freezing only. And there is no appropriate code to use for storage. Can you please help with this situation?

Cryopreservation of embryos

Posted May 28, 2009

What is the correct way to bill cryopreservation of embryos (89258)? If you have multiple days of freezing for one patient's embryos, can you bill each day of freezing or just the initial freeze? Does the code 89258 include the storage?

Cryopreservation and storage of reproductive cells and tissue

Posted May 28, 2009

Does the insurance industry have a designated CPT code for the “cryopreservation and storage” of reproductive cells and tissue?

Procreative Management

Posted March 23, 2009

New ICD-9 codes for 2008: Natural family planning for contraceptive and procreative management.

Fertility Preservation

Posted March 22, 2009

I was wondering how to code for a consultation regarding fertility preservation options when an oncologist sends the patient. In addition, after the consult, if a patient chooses to go through an IVF cycle with embryo cryopreservation, what diagnosis should be used?  


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