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Coding Corner

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Abdominal Paracenteses on Patients

What is the correct code for abdominal paracenteses? We code the first paracentesis as 49080 and subsequent paracenteses are coded as 49081. Are you aware of anything out there in the coding world that gives more information concerning this issue?

Adhesion Lysis

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)?

Ambulatory surgery center billing

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.  Is it considered duplicate billing for both the ambulatory center and embryology laboratory to bill globally?

An IUI Cycle

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?

Anonymous donor services billing

If a patient has IVF coverage which includes donor services, what codes can be used to bill the patient's (recipient) insurance for the anonymous donor services (scans, labs, retrieval, etc.)?  Same question but the recipient is using frozen eggs from a previously stimmed donor?

Antimullerian hormone code

We will start to run AMH (antimüllerian hormone) in our lab.  Can you please tell me what CPT code would be appropriate to use for billing?

Appropriate use of E&M code 99211

Is CPT code 99211 for encounters during cycle management as part of ovulation induction appropriate? 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?

ASC Bill Third-party Payors a Facility Fee

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?

Best code for laparoscopic 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.

Bill a Facility Fee

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

Bill for the Diagnosis Part of Procreative Management

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?

Bill for Semen Analysis

What is the appropriate code for strict criteria morphology alone (without semen analysis)?

Billing 89250 and 89251 on separate days of the same cycle

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?

Billing denial for sonohysterogram

We use a diagnostic code of Z31.41 when billing for a sonohysterogram, but received a denial for CPT 58340 stating this is an invalid combination of CPT and diagnosis codes. Do you have any suggestions?

Billing for a surgical tray in an office setting

When doing procedures such as IVF, SIS, hysteroscopy, sono HSG, IUI, etc., in an office-based setting, is it allowable to bill for a surgical tray?  If so what code do you suggest and is there a standard way to determine the amount to bill?

Billing for color flow Doppler

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?

CPT Code to bill for embryo culture after freezing

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.

Billing for multiple procedures during laparoscopy

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

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.

Billing GYN issues while undergoing infertility treatment

We were billing a patient with no infertility coverage as self-pay for her initial testing. However, in our testing we discovered that she has GYN issues (N84.0 endometrial polyp) and would like to do a sonohysterogram possibly followed by a hysteroscopy. Are these billable under her GYN benefits? Once the issues is resolved, she will continue as self-pay for her infertility needs.

Billing IVF consultation

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 IVF, ovarian stimulation, and oocyte retrieval, is this visit billable, or should it be included in the global charge for the IVF?

Billing patient with anonymous donor

If a patient has donor coverage and uses an anonymous donor how do you bill insurance. Do all the claims go out under the intended parent with the donor code?

Billing OHSS

We have been billing for OHSS and using the code 49083.  From your experience, is there a better or more accurate code to use when the Dr. must remove the fluid after a patient hyperstims?

Billing outsourced HSGs

We have a good relationship with a neighboring hospital, so we are considering outsourcing our HSGs. We like to do our own HSGs because we feel like our technique and interpretation give us so much more information than someone else. However, this is a low reimbursement test. 

Is there a way to be involved to interpret, but someone else do the procedure?  What are different ways to bill for the test/interpretation vs test/follow up consult? Right now we are billing 58340, 74740, Q9967x100 units.

Billing partners separately

Should we (and how do we) code for a male partner consultation. We code only for a new female patient visit but we interact with 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/should we be billing each patient as a new visit? If so, would we just bill the appropriate level of complexity?

Billing regular and 3-D ultrasounds

Can we submit for a regular trans-vaginal ultrasound 76830 and a 3-D ultrasound at the same visit or is it one or the other only?  Do you know in general if there is a higher reimbursement level for 3-D imaging and/or if insurances are currently even accepting submission of 3-D ultrasound for routine examination and diagnostic purposes- 76376/76377, or it is commonly denied?

Billing sperm washing/prep

Our hospital coder has asked why we are using 89310 (semen analysis, motility & count) and for a female patient.  We have always used this code in females using frozen donor sperm.  In many cases, there is no male partner involved.  We also use 89261 (complex sperm isolation) when doing a full sperm wash on fresh sperm and bill it to the female. Is it appropriate to bill sperm washing/prep for IUI to the female or should it be billed to the male?  If it can only be billed to a male, what if there is not a male patient involved?

Blood draw only--how to code?

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?

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

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?

Can I Bill Separately for Interpretation of Semen Analysis Results

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, i.e., 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?

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

Can other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) be used as the sole diagnosis code for an IUI or an IVF cycle?  Are the documentation requirements any different than just N97.9? 

Check for Follicles During Ovulation Induction

Should 76857 or 76830-52 be used for a vaginal probe ultrasound done to check for follicles during ovulation induction? 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 and those services will be paid by the patient who 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?

Code for IUI or IVF without male partner

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?

Also, one more question. 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? 

Code for scratch test

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?

Code for sperm viability test

Is there a CPT code for sperm viability separate from the code used for basic semen analysis? Occasionally, in an IVF/ICSI setting we need to assess viability of immotile sperm with Eosin or with hypoosmotic swelling test.  

Coding difference between egg donation and preservation

I have a provider who is insisting that we use ICD-10 Z52.811 (Egg donor under age 35, designated recipient) for a 35-year-old patient undergoing egg cryopreservation. The patient is not a donor; she is preserving her own eggs for possible pregnancy.  

Please advise if Z31.84 is the appropriate ICD-10 code and not Z52.811. My understanding of Z52.811 is used when a patient is donating eggs to another person.

Coding education and teaching for injectable medications

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?

Coding fertility testing or infertility?

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

Coding fertility treatment for same-sex couples

More insurance policies are beginning to cover the treatment of fertility, but there can be many exclusions and stipulations on these individual policies, such as requiring one year of unprotected intercourse before proceeding with an IVF cycle, which is problematic in the case of same-sex couples. Is there an ICD-10 code we could use to disclose our patient is in a same-sex relationship? We want to fully disclose when filing claims to avoid possible unnecessary confusion for all. 

Coding for amenorrhea

We have a patient desiring fertility who was referred to our clinic for evaluation and treatment due to secondary amenorrhea.  Patient was prescribed letrozole 5 mg orally daily for cycle days 3 to 7 with timed intercourse and is now being followed with ultrasounds.  The provider is insisting that we code the follicle-tracking ultrasounds with the diagnosis of amenorrhea (ICD-10 N91.0). The coder coded the ultrasound with Z31.89 (other procreative management) as the primary diagnosis and N91.0 as the second diagnosis. Provider documented in her note “secondary amenorrhea/FHA here for second cycle." Do we code the amenorrhea as the primary diagnosis? Provider is insisting that we code amenorrhea as primary.

Coding for embryo biopsy over two days

If we biopsy two embryos on day 5 and two embryos on day 6 (for a total of four embryos biopsied), can we submit the code 89290 on both days, since we did two separate procedures separated by one day, or only once since this is only one IVF cycle?

Similar question would apply to code 89258 – can we use the code twice if we freeze some embryos on day 5 and some on day 6, or only once per cycle.

Coding for endometriosis surgery

For a bilateral endometrioma removal in addition to extensive ablation of endometriosis and lysis of adhesions, is there anything other than 58662 that we can use to code this? 

The only code I can find for removing the three ovarian cysts is an open code. Have you any experience with the miscellaneous laparoscopy code 58679, or using the 22 modifier for the 58662 with documentation?

Coding for female fertility preservation

What would the correct ICD-10 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 single-gene defects

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?

Coding for test transfer of embryo catheter in a patient with previous cancer surgery

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.

 

Coding for the infertility testing phase

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 ultrasound with unclear primary diagnosis

What is the appropriate way to code for a baseline ultrasound prior to the initiation of fertility treatments if an ovarian cyst is found and treatments cannot begin?  Would you code the primary diagnosis as infertility with secondary of the cyst?  What about when the patient comes back in a month to see if the cyst has resolved and if treatments can begin, would the primary be the cyst diagnosis since that is what is being evaluated that day with a secondary of infertility?

Coding for Vitamin D testing

Which diagnosis code should we be using for Vitamin D testing, Z31.41 or E55.9?  Most carriers are paying with the testing code but one of our major carriers is denying stating that it would not be covered for the diagnosis of fertility testing.  Can we put E55.9 on a claim when we are not sure if the patient is vitamin-D deficient?  Or is there another code you recommend?

Coding PCOS with fertility treatment

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?

Components of 89250

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, but have not been able to support the professional billing of this code (89250). 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.

Correct coding for evaluation to determine infertility

If a patient and partner present to our office with a 6-month or 1-year history of failure to conceive with no previous testing or treatment, we have been using the Z31.41 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 N97.x or N94.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 insurer who is stating that we should be using the infertility codes. What is the best approach?

Correctly coding infertility diagnosis

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. However, I feel it is important to be accurate when coding. Are there any legal concerns raised by miscoding the diagnosis or is it more just inaccurate?

Correct CPT Code for PGD

I am trying to identify the correct CPT code for preimplantation genetic diagnosis (PGD). Could you help?

Coverage for Infertility

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?

CPT Codes for Telephone Calls

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?

Cyst aspiration coding

If a cyst aspiration (with local anesthetic) is completed in office, what codes could be used for this service in a clinic setting?

Cyst from stimulation cycle

When a patient has a cyst from a previous clomiphene or gonadotropin stimulation 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 add a secondary diagnosis code of N97.x, correct?

Diagnostic hysteroscopy when no abnormalities are found

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.

 

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

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 (N97.x) 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.

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.

Egg retrieval anesthesia

What is the commonly accepted CPT code used for anesthesia given during an egg retrieval?

Embryo storage codes

What the difference is between CPT 89342 (Storage, Per Year; Embryo[s]) and S4027 (Storage of previously frozen embryos)? In what scenarios does the HCPCS need to be used?

Embryo transfer and cervical stenosis

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?

Patient was taken to the OR under general anesthesia. A right-angle retractor was placed anteriorly in the vagina and a weighted speculum posteriorly. The cerclage suture was grasped with a snap and with traction. A uterine sound was utilized to locate the entrance to the uterine cavity. The bladder was backfilled with 120cc of sterile water. Under ultrasound guidance the true passage into the uterine cavity was made with uterine sound. This passage was dilated with small dilator. A embryo transfer catheter was utilized to confirm the location of the tract under ultrasound guidance. Notably the entrance that was more posterior was the true passage and a curve downwards was required to enter the retroverted uterine cavity. No sutures were placed. No stents left in the passage.

Evaluation & Management Service

After evaluating a patient for irregular uterine bleeding, an endometrial biopsy was done. The insurance company denied the consultation and only reimbursed me for the endometrial biopsy. Shouldn't both be reimbursed?

Existing Semen Analysis

Please explain the two new codes and revisions that were made to the existing semen analysis codes. 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

Experimental

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

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?

Female Infertility

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

Fertility Preservation

How should we 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?   

Fertility preservation coding

What code should we use for fertility preservation not related to cancer treatment or before a gonadectomy? I have received mixed response on whether we can use Z31.84 for elective fertility preservation.  ICD-10 coding recommendations on the website did not specify whether fertility preservation recommended for a medical indication versus completely elective are coded differently.

Fertility preservation reimbursement

When we see patients for elective oocyte preservation, we bill with diagnosis code Z31.62 (fertility preservation counseling) or sometimes we use Z31.69 (encounter for other counseling and advice on procreation) for their initial consultation and follow-up visits.  Recently, these claims have been denied as "routine."  Is there another code we should be using?

Follicle monitoring

We bill 76830 (transvaginal ultrasound) every time they perform an ultrasound even when monitoring the patient’s follicle. Should we be billing 76857 (Ultrasound pelvic limited or follow up) [e.g. for follicles]). The endometrium is also examined and reported, see below:

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

Follicle ultrasound code

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.

Gamete donor screening billing

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? 

Gender-specific CPT codes

Can the retrieval of donor eggs and the transfer of donor eggs to a recipient be billed to a male?  We have an unusual situation and have been told that we can bill these services to a male however, my understanding is that the bloods and ultrasounds, and particularly the retrieval and transfer are gender-specific CPT codes, meaning we can only bill to a female.  Are there any instances of gender neutral codes (other than ICSI), or are we interpreting the coding guidelines correctly?

Hysterosalpingo Contrast Sonography

What is the appropriate code for HyCoSy (Hysterosalpingo Contrast Sonography) (an SIS/SHG that includes the fallopian tubes and airbubbles in the saline via catheter)? 

Hysteroscopic transcervical fallopian tube cannulation

How should hysteroscopic transcervical fallopian tube cannulation under laparoscopic guidance be coded? The code for cannulation is 58345, are there additional codes for the hysteroscopy and the laparoscopy?  Are any modifiers required?

ICD-9 code for oligo-ovulation

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)?

ICD-9 code for recurrent implantation failure

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

Image Documentation for Ultrasound Follicle Checks

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?

 

Infertile couple diagnostic coding

Is the code Z31.41 the correct code to use for diagnostic testing of an infertile couple? And, If so, can it be used as the primary and only code?

Infertility and the Etiology

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.

Infertility Counseling

In accordance with ASRM practice recommendations, 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?

Initial Visit for Infertility

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.

In-office hysteroscopy

If a hysteroscopy procedure is done (58555) in the office with a Endosee Scope, can i still use the same code even though it is in the office?

Insurance companies deny the embryo thaw 89352

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 anywhere that these are bundled procedures.

Intrauterine Insemination (IUI)

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?

Intrauterine Inseminations Performed by Nurses

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)?

Introduction of Saline or Contrast

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?

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

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?

IUI coding

What is the correct ICD-10 diagnosis code for the CPT 58322 (artificial Insemination, Intra-uterine)?  Most coding books recommend N97.0 or N97.8, but we have encountered other literature, mostly on carrier websites on reimbursement policies, that recommend that 58322 be submitted on a claim with an ICD-10 PCS code of 3E0P3LZ or 3E0P7LZ.  While the CPT code for AI is found in the coding section with other GYN surgical codes, it is not a “surgery” so we believe the carrier’s policy recommending the use of 3E0P3LZ or 3E0P7LZ would be incorrect coding.  Do you have a coding guideline for this situation?

IVf donor egg retrieval

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? 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”?

IVF insurance billing guidelines

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.

Lab Portion of PGD

Have any new codes been introduced for the lab portion of preimplantation genetic diagnosis (PGD)?

Laparoscopic Lysis of Omental Adhesions

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.

Monitoring an IUI cycle

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.

More than one diagnosis code

We have coded for bilateral neosalpingostomies using only a diagnosis of N70.11 (Hydrosalpinx). Yet, for the office-based care of a patient with PCOS and infertility, both diagnoses are required for correct coding. Do you agree with either or both coding approaches, which seem inconsistent?

Multiple days of freezing embryos

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?

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

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

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

New Infertility Patient

How soon can you bill as a new infertility patient? If a patient has not been seen since 2014 for infertility and is now returning for infertility in 2016, would they be considered a new patient? What is the time frame to bill again as a new patient?

Oocyte aspiration

Should oocyte aspiration be coded as a bilateral procedure?

Out of Town PGD

Our clinic is just starting to do PGD and brings 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 airfare, hotel, eating expenses, and the embryologist’s professional charges and laboratory charges. 

Ovulation management fee for ovulation induction

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?

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.

Perform IUIs

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?

PGD Performed Due to a Genetic Disorder

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?

PGS testing with next generation sequencing

What codes are appropriate for PGS testing with next generation sequencing?  We know what codes to use for the actual biopsy, but are receiving conflicting information on the testing information.

Possible infertility

If a prescriber is trying to determine if the female has infertility and must run diagnostic tests (i.e., 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 to 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? 

Pregnancy test after IUI

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?

Pre-IVF Testing

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

Preservation and Storage

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

Procreative Management

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

Purchasing donor eggs

We have a patient interested in purchasing donor eggs. Is the a specific CPT code to be used for insurance billing purposes?

Recurrent Miscarriages

When seeing a patient for the first visit for recurrent miscarriage, is it appropriate to use the diagnosis codes Z31.69 (procreative management) as a primary code and N96 as a secondary code?

Recurrent Pregnancy Loss Coding

Our physicians have struggled with 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 N97.X. There are very few patients who are not infertile but are RPL (N96), and in their recurrent pregnancy loss work up, the only finding is progesterone deficiency. These patients will usually be prescribed clomiphene citrate to correct this deficiency and prevent miscarriage. Should their diagnosis code be N97.9 or N96 for ovary checks and ultrasounds? I am afraid if we bill it with a N96 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 N96 and have not been able to conceive again, and in these cases when clomiphene citrate is prescribed, we feel it is appropriate to bill with a N97.9 diagnosis code.  

Resection of Rudimentary Uterine Horn

For a laparoscopic resection/removal of a rudimentary uterine horn, would it be proper to use CPT code 58541 with a modifier -52 since only the extra portion of the uterus is being removed (and not the entire uterus)?

Screening Tests Performed

What is the correct ICD-9-CM Coding for screening tests performed by physicians treating infertility patients?

Semen analysis without IVF

How do I to code for a straightforward standalone semen analysis versus an analysis performed as part of an IVF cycle (see list below)?   The carrier policies and the CPT book do not provide additional information about what is bundled or billing circumstances. 

The ASRM correct coding Guide lists these codes, but I need more detail about when it is appropriate to bill each code  (any bundling issues when billed with a cycle).  I also need to know the documentation requirements to support each code.   For example, do we have to document the number of oval, tapered heads, etc. for 89320, and is 89261 more appropriate for  pre-IVF analysis (and is that billable along with cycle charges)?  When is it appropriate to only bill 89310  vs. billing 89320 (and what documentation is required to distinguish between the two).

Sonography

First Trimester Ultrasound Denials

Sperm wash coding

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.  Would N46.8 (Male Infertility-other) be appropriate?

Sperm Wash for IUI

When billing a sperm wash (58323) to an insurance company, we receive $10-$20 reimbursement (from the female). Does the sperm wash code cover the semen analysis and morphology, or can we bill separately under the male for these services? 

Summary of Coding for Recurrent Pregnancy Loss (RPL)

Strategy for coding for a patient with RPL - codes compiled by the ASRM Coding Committee. Many aspects of the evaluation and treatment of recurrent pregnancy loss (RPL) remain controversial. This document is limited to the most common and well-established etiologies and treatments and should not be considered an exhaustive list. In some cases, individual insurance companies produce “Clinical Policy Bulletins” that outline which tests or treatments they have designated as “medically necessary” vs. experimental/investigational, and may serve as helpful guidance in regard to insurance coverage decisions.

Summary of Common Codes for Endometriosis

A summary of common codes for Endometriosis compiled by the ASRM Coding Committee. Endometriosis is a particularly difficult field for coding owing to extensive variability in symptoms, severity, and location. Severe disease can result in subspecialty support from gynecologic oncology, urology, general or colorectal surgery, and even cardiothoracic surgery in the case of diaphragmatic endometriosis. Though there are exceptional reproductive surgeons capable of procedures normally reserved for other fields, this summary will focus on conditions and procedures that can be performed by the majority of REI’s and OB/GYN’s.

Surgery

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

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 birth control pills on Sunday, would this be appropriate to code as 99371?

Transferring billing to another account

We receive requests from patients to have lab work drawn on the female patient moved to the male's account due to the female fertility coverage being maxed out. The male still has coverage however. Is there a way to do this? What would the correct diagnosis code be, Z31.41?

Transgender injections post surgery

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.  We initially had coded it as Z87.890 and 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.

Twin pregnancy and transvaginal/transabdominal 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 651.03 (twin pregnancy). Recently, we have been denied payment for the ultrasound done on the second sac 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. 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 the payor correct in denying payment for the second ultrasound exam?

Ultrasonography with embryo transfer

Can we use code 76998 for the guidance as this patient is being seen in the Surgery Center? Currently, we are coding 76705 but recently were audited by an outside company who is stating that we should be using code 76998.  How do you code for Ultrasonography performed at the time of an embryo transfer?

Updates to CPT code set for 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.

When to bill an E&M code

Our office currently bills only 76857 (along with appropriate blood levels) when a patient is being monitored.  My peer asked me why we don’t bill an e/m code with the 76857, as her physician does.  I explained to her that a physician probably should not be billing the e/m code if the documentation does not support the visit.  Technically the patients are just coming in for follicle monitoring and not evaluation and management. 

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