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All Coding Corner Questions

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Abdominal Paracentesis

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?

Assisted Hatching Billed With Embryo Biopsy

Do you know if both assisted hatching (89253) and embryo biopsy for PGS/PGD/CCS (89290/89291) can be billed during the same cycle? For example, AH on day three, embryo biopsy on day 5/6 during blast stage. Or, does the embryo biopsy essentially take the place of AH when performed?

Assisted Zona Hatching

Can assisted hatching and embryo biopsy for PGT-A; PGT-M or PGT-SR be billed during the same cycle? 

Blood Draws

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?

Blood Tests

We are getting numerous calls from patients requesting to have lab work drawn from the female patient moved to the males account due to the female fertility coverage being maxed out. The male still has coverage however. We are wondering if there is a way to do this? We had a speaker come in once to teach about fertility and from what I remember she called them out of body lab services and said they were movable. The one questions I have is what would the correct DX code be? Could we use Z31.41?

C-Section Ectopic Pregnancy

I’m writing for advice for CPT advice for managing cesarean scar ectopic pregnancy without concurrent intrauterine pregnancy (ICD-10 O00.80). The patient wished to avoid laparoscopy/laparotomy and underwent transcervical balloon therapy which was inflated adjacent to the ectopic (as has been described/published previously) without success. Several days later during the same inpatient admission, she underwent general anesthesia with ultrasound guided installation of potassium chloride and methotrexate directly in to the ectopic pregnancy, which was successful and she was discharged home the following day.

D&C Under Ultrasound Guidance

What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix s/p trachelectomy with cerclage placement taken to the OR for dilation of lower uterine segment under ultrasound guidance with passage of uterine sound and embryo transfer catheter?

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.

Diagnosis of Infertility for IVF Procedure

How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures?  My partners use unexplained infertility (N97.9) for everyone saying it doesn't matter for insurance. I feel it is important to be accurate in coding always but am I just overthinking this? Is there any concerns legally by miscoding the diagnosis or is it more just inaccurate?

Diagnostic Hysteroscopy

I am hoping you can help. If the doctors do a hysteroscope #58555 in the office with a Endosee Scope, can I still use the same code even though it is in the office?

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.  Medicare guidelines are being quoted as stating the Z11.3 is not a proper principal diagnosis code.  Do you have any suggestions/feedback on an additional/alternate diagnosis code?  We are having difficulty finding one that is more appropriate. Thanks so much!
138828 Donor C. Trachomatis/N.Gonorrhoeae; 138930  Donor CMV Total w/Reflex to IgM and IgG; 138699 Donor HBcAb Total; 138749 Donor HBsAg w/Reflex to confirmatory neut. Assay; 138907 Donor HCV Ab; 138931 Donor HIV-1/HIV-2 Plus O w/ Reflex to HIV-1 WB; 138780 Donor HTLV-I/II Ab w/Reflex to Immunoblot; 139240 Donor Procleix Ultrio Assay; 139280 Donor Syphillis (T-Pallidum IgG); 139486 Sperm Donor Viromed Panel.

Donor Egg Lot Acquisition

What is the code for egg lot acquisition?  In other words, the donor match fee or egg procurement.  An agency finds her, does physical and mental screening and charges one lump fee.

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? We know the FDA requires a significant screening but cannot find any details on the code to bill for this if and when insurance is involved.

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? How do you identify the donor egg retrieval on the recipient’s claim?

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?

Donor Screening

I am emailing on behalf of CCRM/Member is Steve Gerson (12077).  Is there a specific CPT code used for Donor Physical Exams or would a practice just bill using the appropriate E&M Code? We know the FDA requires a significant screening but cannot find any details on the code to bill for this if and when insurance is involved.            

Donor Sperm IUI Single Women

How do I code for therapeutic donor insemination for an unmarried female with no known fertility issues except no partner?             

Egg Culture and Fertilization

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.

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 of donor eggs be fertilized with sperm from male #2.  How should this be billed? Specifically, in our split donor egg cycle for this same-sex male couple, we performed two separate sperm preps, two fertilization procedures (in this case, one was fertilized by ICSI and the other by IVF).  We kept the two sets of embryos in separate dishes to culture and monitor extended culture of their embryos under separate case IDs, then we froze each embryo individually and stored each set of embryos created from each of the partners in separate canes. 

Elective Single Embryo Transfer

Has any progress been made in creating/obtaining a specific CPT code for an elective single embryo transfer (eSET)?  This would be most beneficial from a provider and payer perspective.

Embryo Biopsy

Have any new codes been introduced for the lab portion of PGT?

Embryo Biopsy Embryologist Travel Costs

Our clinic is just starting to do PGD.  We currently fly in an embryologist to perform the biopsy procedure.  Can we bill insurance for the biopsy procedure?  Can we bill for travel expenses?

Embryo Co-culture

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?

Embryo Culture Denied As Experimental

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?

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 or is it only submitted one time over the multiple days of culture? Same question for 89272.

Embryo Freezing/Thawing

Our question refers to the CPT code 89258 “Cryopreservation; Embryo(s)” and 89352 “Thawing of Cryopreserved; Embryo”. Our question is when we cryopreserve embryos for a patient on multiple devices (CryoLock, CryoTip, CryoLef, etc. whichever device the laboratory is using), is it appropriate to charge the patient per device using this code? We are using more than one device and also using media with the suggested protocol per device, so we would ideally like to charge for the cryopreservation of embryos per device.      This question then also leads into thawing. If a patient requests to have two devices thawed for an FET (frozen embryo transfer) how can we charge per device when thawing embryos?

Embryo Thawing/Warming

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.

Endometrial Biopsy/Scratch

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? 

Endometrial Receptivity Analysis

Our physicians are going to start doing an Endometrial Receptivity Analysis.  Do you know the appropriate CPT code that should be used?

Endometriosis and Infertility

If the patient presents with an inability to conceive and has been elsewhere or previously gone through treatment and the infertility was diagnosed prior as being related to endometriosis, would the N97.x codes come first or would endometriosis be the primary diagnosis for the initial consult? Also, for treatment like IVF would we bill with N97.x first or an endometriosis diagnosis?

Excision Ovarian Endometrioma

When a laparoscopic excision of endometriosis and an ovarian excision of endometrioma with bilateral ureterolysis is performed, what CPT codes is reported?  Can we also bill  separately for the bilateral ureterolysis if the ureterolysis was done from pelvic brim to uterine artery and include retroperitoneal fibrosis which endometriosis patients typically have? 

Fertility Preservation Consult

What code are we supposed to use for counseling regarding fertility preservation for an individual with cancer, or for fertility preservation not related to cancer treatment or before a gonadectomy? In addition, after the consult, if a patient chooses to go through an IVF cycle with oocyte or embryo cryopreservation, what diagnosis should be used?   

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, do code the ultrasounds with E28.8 as the primary diagnosis or Z31.89 or N97.1 as the primary code then E28.8?            

Gamete Thawing/Warming

Can patients be charged for each vial/straw of reproductive gametes or tissues thawed? 

General E&M Consult

Recently we have received a “re-code” on a new patient (we billed a 99203 and the insurance re-coded it to a 99213). The patient was a new patient, however had seen us for an HSG, ordered by her OB/GYN. The insurance company states we cannot bill an E & M for a new patient since she had already seen us.  Our doctor did not do any type of consult/physical or office visit, we strictly performed a procedure ordered by another physician outside of our practice.

Genetic Counseling

Does ASRM have any guidance for how to bill for genetic counseling services provided by a genetic counselor?

Gestational Carrier

I would like to confirm ASRM’s opinion on the best code to use for a gestational carrier cycle.   The code I have located is Z31.89 (Encounter for other procreative management), but I would appreciate a second opinion. 

HSG Denied As Bundled Or Incidental

I posted this coding question to the ARM discussion thread last week and didn’t get any responses.  I’ve also gone through your old coding posts and cannot find this specific question.  Is there someone on your team that could answer this question please?  This is what we are currently using and was recommended by the rep: 58340, 77002, Q9967, 74740, 99213-25                77002 commonly is being denied as bundled or incidental and most recently we are having problems with Anthem for the office visit.

HSG Using Fertility Testing Code

With the new ICD 10 coding it appears that using a code of "fertility testing" rather than infertility is more likely to be covered for HSG procedures. Is this true and should it be used?  "Fertility testing" - N31.41 is the code.

Hysterosalpingo Contrast Sonography

As a new practice, we are having trouble finding the appropriate code for HyCoSy (Hysterosalpingo Contrast Sonography -an SIS/SHG that includes the fallopian tubes and air bubbles in the saline via catheter.) Since it is a relatively new procedure, we would love some guidance or maybe feedback from other practices who perform it.

Hysteroscopic Tubal Cannulation Under Laparoscopic Guidance

How can one code for hysteroscopic transcervical fallopian tube cannulation under laparoscopic guidance? I know the code for the cannulation is 58345. Are there additional codes for the hysteroscopy and the laparoscopy.  Are any modifiers required?

Hysteroscopy Polyp Suspected

What ICD-10 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?

Hysteroscopy Recurrent Implantation Failure

What is the appropriate ICD-10 code for recurrent implantation failure? The provider performed a diagnostic hysteroscopy for a patient with recurrent implantation failure.

Hysteroscopy Resection of Retained Products of Conception

What CPT is appropriate for a Hysteroscopy Resection of Retained Products of Conception? In the past, I have used the unlisted CPT code 58579, but the claim is always denied for a more specific CPT code. Thank you for your assistance.

ICSI and Embryo Biopsy

How to bill for ICSI or embryo biopsies that occur in different days? So if 8 eggs were ICSI fertilized on one day but then the next day 4 more were ICSI’d would we then bill the 89281 code for the second day?  Same with PGTA?

Infertility Consult

Does ASRM have any examples of evaluation and management documentation for patients being seen for an initial infertility evaluation? I am trying to give examples of how providers can document level 4 or 5 new patient visit when being seen for infertility. Not sure how a provider can get 4 HPI elements, complete ROS and comprehensive physical examination when a patient is seen for infertility. If a 36 year old seen for secondary infertility. Trying to get pregnant for three years with un-protective intercourse. Example: Infertility=location, Secondary=context, and three years=duration, un-protective intercourse=modifying factors. Would complete ROS and comprehensive physical examination be medical necessary for “infertility” for a patient with no preexisting problems? My provider wants to bill the level 4 and 5 visits, but does not want to document time.

Initial Visit for Infertility With No Mandated Coverage

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.

Intralipids Infusion

Do you have any information on how to code for intralipid infusions? Our NP has indicated on the billing slip 36410, 96367, J7050.

IUI

We are seeing conflicting information about the correct ICD-10 diagnosis code for the CPT 58322, Artificial l Insemination, Intra-uterine. 

Most of our coding books recommend N97.0 or N97.8, but we have encountered other literature that suggests the use of the ICD-10 PCS code of 3E0P3LZ or 3E0P7LZ. 

IUI or IVF

Our practice would like some guidelines on whether other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used as the sole diagnosis code for an IUI or an IVF cycle.  Are the documentation requirements any different than just N97.9? 

IUI Performed By Nurses

In our office, nurses perform the IUI and credit the ordering physician.  

We have the following questions:

  1. Are there any legal concerns with malpractice in having the nurse perform these services instead of the physician?
  2. Can we bill an insurance company for an IUI performed by an RN?
  3. Must the physician be physically present in the office at the time of the IUI in order to bill for the service?

IUI Performed By Nurses With E/M

At our center, the intrauterine inseminations are performed by our nurses. At the time of the insemination our nurse assesses the patient 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 the standard charges for the insemination and sperm prep, can we also bill the evaluation management code 99211 with a modifier (-25)?

IUI Same Gender

When managing an IUI or IVF cycle for a female same sex couple or a patient that has no exposure to sperm, what ICD 10 diagnosis should be used?

IUI Sex Preselection

What is the proper ICD-10 code to use for a patient undergoing artificial insemination purely for sex preselection?

IUI With E/M

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?

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?  Or, is this IV fluid part of the reimbursement rate for 58970 follicle puncture?  We are a state-registered surgical practice, but we do not bill out facility charges.  We submit for all retrieval and IVF lab coding.

IVF Billing Forms

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.

IVF Billing Globally

I am the Practice Manger of a fertility group.  We have a clinic and an ambulatory surgery center.  When billing a retrieval, we bill out a 58970 and 76948-26 under the physician, we bill the 89261, 89254, 89250, 89280 89272 and 89253, 89258 from our Embryology Lab with the same tax id.  Our surgery center additionally bills out the facility charges, billing out 58970 and 76948-TC and is billing out the 80000 codes as well.  It appears to me that the 80000 codes should either be billed by the lab with modifier -26 and the surgery center with modifier –TC or billed globally by the embryology lab.  I am correct in assuming that it is duplicate billing for both the ambulatory center and embryology laboratory to bill globally?

IVF Billing of Professional Charges

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

IVF Consent Counseling

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?

IVF Lab vs Physician Practice Billing

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?

Lab RVUs

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

Limited Monitoring Ultrasound

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? 

Male Consult

My group was wondering if and how to code for a male partner consultation. We and others we know code only for a new female patient visit but we do see both the male and female, take two histories,  do a physical exam on both, and engage them both in education and decision making and well as order labs and a semen analysis. Can and should we be billing each patient as a new visit? If so, would we just bill the appropriate level of complexity?

Medication Administration

We administer Zoladex and Depo-Lupron in office.  This is a nursing visit with injection service.  Is CPT code 96402 applicable to a Depo-Lupron or Zoladex injection by nurse at REI practice, even if there is no diagnosis of cancer?  If not, would CPT code 96372 be more accurate? Do we code differently if we are providing/supplying the Depo-Lupron or Zoladex and doing the injection, versus if the patient brings in the medication and we inject it for them?

Medication Teaching and/or Administration

I see in the coding corner it is recommended that CPT code 99211 be used for education and teaching for injectable medications.  If a patient were to come in strictly for the injection, without any type of direct training, what CPT would be appropriate? We are currently investigating 96372 but figured I should submit to the experts.  Also, could the CPT code for the injection itself be billed with 99211 or is 99211 all encompassing? Thank you!!

Monitoring E&M

Our group would like to know if others are billing an evaluation and management code for ultrasound and blood draw visits?

Monitoring FET

What is the correct diagnosis code to use on the follicle ultrasound (76857) for a patient who is undergoing frozen embryo transfer (FET)?

Monitoring Ovulation Induction By Nurses

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?

Multiple Laparoscopic Procedures

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.

New vs Established Patient

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?

Office Hysteroscopy Billing

We are doing in office hysteroscopy now. Do you all have a resource that details what all can be billed, or what all is bundled with the 58558 procedure when done in office? For example, IV start, medications, saline.  Regarding IV start, we also had the question as to whether to use 36000 vs 36410 if our Nurse Practitioner is the staff member starting the IV. 

Office Testicular Aspiration

We are inquiring about a coding question for testicular aspirations.  What is the consensus for the code used for testicular percutaneous aspirations done in the office? 

Oocyte Aspiration

Should one bill oocyte aspiration as a bilateral procedure?

Oocyte Preservation Consult

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 Z31.62 (fertility preservation counseling) or sometimes we use Z31.69 (encounter for other counseling and advice on procreation).  Recently, BCBS started denying anything that we bill with these two codes because they consider them “routine”.  Do you know of any other ICD-10 we can use when the patient comes in for consults/follow ups?

Ovariopexy

Is there a CPT code for Ovariopexy procedure only, via mini-laparotomy?

Ovulation Induction Monitoring for IUI

We would like to clarify the correct ICD 10 diagnosis code for monitoring of an IUI cycle.  We are currently using Z31.83, encounter for assisted reproductive infertility cycle.  The other option being considered is Z31.89, encounter for procreative management. 

Ovulation Induction Monitoring With PCOS

We have a patient insisting that we code the ultrasound follicle monitoring with the PCOS diagnosis. 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 N97.0 codes or the Z31.89 and the PCOS can be a secondary diagnosis. Is this correct?

Patient Education

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.

Pregnancy Of Uncertain Viability Ultrasound

When patients achieve pregnancy, I follow them for 12 weeks prior to referring them to an OB provider. My staff is telling me that I am getting reimbursed for the first sonogram and OB visit (using ICD 10 code for pregnancy of uncertain viability – O36.80X0.

Pregnancy Of Unknown Location

What is the most appropriate ICD-10 code for pregnancy of unknown location (not an ectopic pregnancy)? What CPT code would be most appropriate for a manual uterine aspiration for a pregnancy of unknown location?

Pregnancy Test

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? 

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. 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?

Prewashed Sperm

I have a question regarding prewashed sperm and billing for this service. It appears there is a premium being placed on prewashed sperm, but I find nothing in the code definitions for sperm washing or even in the clinical guidelines of each insurance carrier that distinguishes this service as covered.

Psychological Evaluation

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? 

Recurrent Pregnancy Loss

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 Z31.69  (procreative management) as a primary code and N96 as a secondary code?

Resection Adenomyoma

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.

Results Review

What CPT code is most appropriate to submit for Physician Time to review CCS/PGS/PGD results? I saw some information online that a preventative medicine E&M code could be used, but not sure how accurate that is.

Retrograde Semen Analysis

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

Robotically Assisted Tubal Anastomosis

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.

Same Day Consult and Procedure

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?

Self-referred New Patient

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.

Semen Analysis and Interpretation

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?

Semen Analysis CPT and CLIA Certification

I am seeking clarification of conflicting information we have researched for our practice. Listed below are the two coding corner responses that seem to provide conflicting information regarding CPT code 58323. Our specific question is does 58323 include count and motility analysis? If so, how can that be performed in a lab that does not have CLIA certification? It is my impression that counts can only be performed in a CLIA certified lab.

Semen Analysis For Assessment of Fertility

What is the appropriate diagnostic code to use for a semen analysis for the assessment of infertility? Is fertility testing used for males? How about children and adolescence with specific structural problems or testicular failure?

Semen Freezing

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-10 code to use in this situation?

Semen Leukocyte Assay

What CPT code is applicable for a Semen Leukocyte Analysis or a Reflex Leukocyte Assay?

Semen Morphology Without Analysis

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

SHG/HSG

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?

Sperm DNA Fragmentation

Is there a CPT code for HALO DNA Fragmentation for sperm?  I tried researching and the only code recommended is an unlisted code, CPT 89240.  If this is the only code use to report, what CPT code do cross match for pricing?

Sperm Prep No Male Patient

Is it appropriate to bill sperm washing/prep for IUI to the female or should it be billed to the male?

If so, what if there is not a male patient involved?

Sperm Prep With Handling Fee

Could we charge for the thaw of sperm, then a handling fee (99000) to represent the fact that the sperm was prewashed or are these services always bundled into 89260/61?

Sperm Wash

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.

Sperm Wash No Male Factor

What would be the best code to use for a sperm wash when it is not a male factor issue?  There is a code for male factor in a female patient, but not a code for a female factor in a male patient.  My thought would be to use “Male Infertility-other” (N46.8).   Can you please confirm?

Surgery Coding

Several years ago, I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of N70.11 (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?

Telephone Consult

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?

Testing With No History of Infertility

I came across your site as I was trying to do some research on what diagnosis codes providers should submit to insurance carriers while trying to evaluate fertility issues. If the prescriber is trying to determine if the female has infertility and must run diagnostic tests (IE lab work, HSG, ultrasound, etc...) that the patient has not obtained previously, and the patient does not have a diagnosis of "female infertility" from another OB-GYN, is it appropriate that the doctor use the diagnosis code of "female infertility" without knowing any results of lab work or a HSG to confirm infertility? Rather, should a diagnosis code that states that the patient is being evaluated for fertility issues, be used instead?

Tompkins Metroplasty

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.

Transgender Care

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 Z87.890 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 F64.0.  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.

Transvaginal Cyst Aspiration

If a cyst aspiration is completed in office, what codes could be used for this service in a clinic setting?  This would be with a local anesthetic only. 

Trial Transfer

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

Twin Pregnancy Ultrasound

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 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 then 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?

Ultrasound for Ovarian Cyst

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 N83.x diagnosis if the patient will take that cycle off? There is not a need to put a secondary diagnosis code of N97.x is there?

Ultrasound Images

During ultrasound for follicle checks, does an image need to be saved to a chart?  Are there documentation and image requirements for this type of service?

US Embryo Transfer

At the meeting, we learned about the CPT code 76705-Ultasound guidance for embryo transfer, can this code be billed with CPT code – 76942. Or is it an either or situation?

US Embryo Transfer in Surgery Center

Can we use code 76998 for the ultrasound guidance as this patient is being seen in the Surgery Center? Currently we are coding 76705 and have been for years but recently we have been audited by an outside company who is stating that we should be using code 76998. I would just like a detailed description on whether or not this code is valid. As we think it could be more appropriate for this type of service.

Uterine Sounding

Is there any specific CPT code(s) for uterine sounding? (Referring to cannulating the cervix and “sounding” or measuring the uterine height)

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