Exclusion of IVF services due to Z31.83
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000), but BCBS keeps denying it due to the exclusion of the Z31.83 diagnosis code. BCBS, as outlined in my coverage, does cover the various IVF CPT codes, but the one diagnosis code associated with the treatment they won't cover and are, therefore, refusing to cover infertility treatments.
Some background: My wife has stage 4 endometriosis and hydrosalpinx. She had surgery a few years ago to have her tubes repaired/drained but the damage was so great that the surgeon could only remove one tube as he "couldn't discern her anatomy". Where we had to go to a specialist to perform robotic-assisted surgery to remove her other tube and "clean up" her lower abdomen due to significant adhesions and remove endometrioid cysts. On one hand, the fertility clinic says Z31.83 is the only diagnosis code that can be used for the actual treatment (i.e., embryo transfer), and on the other, BCBS won't cover it and is telling the clinic to use another diagnostic code. While I have no doubt the clinic is correct, there's got to be something I'm missing.
I reviewed online regarding cycle coordination fees, but it states that there is no specific code for cycle management. An alternative would be 99499. One of our locations presented S4042 for cycle management. Would this be considered appropriate?
Some background: My wife has stage 4 endometriosis and hydrosalpinx. She had surgery a few years ago to have her tubes repaired/drained but the damage was so great that the surgeon could only remove one tube as he "couldn't discern her anatomy". Where we had to go to a specialist to perform robotic-assisted surgery to remove her other tube and "clean up" her lower abdomen due to significant adhesions and remove endometrioid cysts. On one hand, the fertility clinic says Z31.83 is the only diagnosis code that can be used for the actual treatment (i.e., embryo transfer), and on the other, BCBS won't cover it and is telling the clinic to use another diagnostic code. While I have no doubt the clinic is correct, there's got to be something I'm missing.
I reviewed online regarding cycle coordination fees, but it states that there is no specific code for cycle management. An alternative would be 99499. One of our locations presented S4042 for cycle management. Would this be considered appropriate?
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