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.
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
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.
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?
Diagnosis code for donation
What is the diagnosis code for an embryo donation versus egg donation?
Mandated states and egg retrieval
What name should you use to submit for reimbursement for the actual egg donor when there is benefit for the donor egg retrieval?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 third-party reproduction
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
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
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
Diagnosis code for donation
What is the diagnosis code for an embryo donation versus egg donation? View the Answer
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
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
Misconduct in third-party assisted reproductive technology by participants and nonmedical professionals or entities: an Ethics Committee opinion (2023)
In some instances, it is ethically permissible for the physician to either disclose material information to the affected party or to decline to provide or continue to provide care. View the Committee Opinion
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
Gestational Carrier
I would like to confirm ASRM’s opinion on the best code to use for a gestational carrier cycle. View the Answer
Diagnosis Code For Same-Sex Egg Donation
We have a same-sex male couple with insurance coverage for IVF. View the Answer
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
Donor Egg Lot Acquisition
What is the code for egg lot acquisition? View the Answer
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
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
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
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
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
Claim Form for Donor Egg Retrieval
What bill form is used of IVF donor egg retrieval? View the Answer
