See what you missed at ASRM 2024 with the ASRM 2024 Recorded Bundle 

Menu
Close Close Icon

Submitting female codes under a male patient in a donor cycle


We got a rejection from the clearinghouse for using a female diagnosis under a male patient. My previous manager stated that it has to be billed under the intended parent (IP) because the donor is not on the policy.

Our software vendor advised: "The first step is to confirm that it's supposed to be billed like this. At least one state BCBS is asking people to put the policy on the donor and submit the claim with the donor as the patient and a note in box 19 that they are an egg donor."

Is this correct? He also suggested we reach out to the payer to get something from them that we can forward to the clearinghouse but I am concerned that procuring something like that would be difficult.

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
Coding Third Party teaser

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. 
Coding Third Party teaser

Mental health assessment for donors and intended parents

Is it appropriate to use 96156 or 96167 for mental health professional (MHP) counseling of gamete/embryo donors and gestational carriers?
Coding Third Party teaser

Diagnosis code for donation

What is the diagnosis code for an embryo donation versus egg donation?
Coding Third Party teaser

Submitting female codes under a male patient in a donor cycle

We got a rejection from the clearinghouse for using a female diagnosis under a male patient. 

Coding Corner


Coding Corner is segmented into the following sections. Click an image below to view questions and answers in that section.


Coding_Andrology_Teaser.png
Coding_ARTClinicalCare_Teaser.png
Coding_ART_Lab_Teaser.png
Coding_Surgery_Teaser.png


Coding_ThirdParty_Teaser.png
Coding Summaries_Teaser.png
Coding_ChairLetters_Teaser.png
Coding Documents_Teaser.png

More Resources

MAC 2021 teaser
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.

View the MAC Tool
EMR Phrases teaser
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.

View the library
Practice Committee Documents teaser

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.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
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.

View the Q & A
Covid-19 teaser
Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

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.

View Website

Topic Resources

View more on the topic of third-party reproduction
Coding Icon

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
Coding Icon

Mental health assessment for donors and intended parents

Is it appropriate to use 96156 or 96167 for mental health professional (MHP) counseling of gamete/embryo donors and gestational carriers? View the Answer
Document Icon

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled. View the Committee Document
Coding Icon

Diagnosis code for donation

What is the diagnosis code for an embryo donation versus egg donation? View the Answer
Coding Icon

Submitting female codes under a male patient in a donor cycle

We got a rejection from the clearinghouse for using a female diagnosis under a male patient.  View the Answer
Coding Icon

Billing donor services to IP’s insurance

When an intended parent has donor coverage under their insurance, how do we bill the donor services to their insurance? View the Answer
Coding Icon

Reimbursement for 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
Document Icon

Misconduct in third-party assisted reproductive technology by participants and nonmedical professionals or entities: an Ethics Committee opinion (2023)

In some instances, it is permissible for the physician to disclose information to the affected party or to decline to provide or continue to provide care. View the Committee Opinion
Document Icon

Defining embryo donation: an Ethics Committee opinion (2023)

The ethical appropriateness of patients donating embryos to other patients for  family building, or for research, is well established.
View the Committee Opinion
Coding Icon

Gestational Carrier

I would like to confirm ASRM’s opinion on the best code to use for a gestational carrier cycle.  View the Answer
Coding Icon

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
Coding Icon

Diagnosis Code For Same-Sex Egg Donation

We have a same-sex male couple with insurance coverage for IVF.  View the Answer
Coding Icon

Donor Egg Infectious Disease Lab Screening

The issue we are experiencing is outside labs billing with Z11.3 are getting denials stating improper ICD-10 for the services billed.  View the Answer
Coding Icon

Donor Egg Lot Acquisition

What is the code for egg lot acquisition? View the Answer
Coding Icon

Donor Eggs-Physical Exam

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
Coding Icon

Donor Egg-Retrieval On Recipient's Claim

Is the donor egg retrieval included on the bill to insurance with the first IVF treatment for the recipient?  View the Answer
Coding Icon

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
Coding Icon

Claim Form for Donor Egg Retrieval

What bill form is used of IVF donor egg retrieval? View the Answer
Coding Icon

Coding For Donor Egg Retrieval For Male Intended Parent

In coding a donor-egg retrieval to bill to insurance under the male intended parent, would it be appropriate to use the Z31.83?  View the Answer