All Coding Corner Questions
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Posted
Feb 08, 2021
How should I bill for 3-D sonography?
Posted
Mar 03, 2021
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?
Posted
Mar 28, 2022
One of my physicians has a private office with no access to an embryology/andrology lab but does use an outside facility to perform the retrievals and transfers. The facility is not billing insurance for the lab services. Would my physician be able to bill for professional and lab services under his NPI and tax ID if ALL services are being performed at this outside clinic?
Posted
Mar 28, 2022
Unfortunately, our physician tested positive for COVID-19, so we have another physician that is not associated with our office performing our egg retrievals and embryo transfers. I believe the other office should bill for CPT 58970 or 58974 with mod 26 and we would bill with mod TC along with the other testing our embryologist performs.
Posted
Mar 08, 2021
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?
Posted
Mar 08, 2021
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?
Posted
Mar 28, 2022
Is coding/billing any different when a non-board certified or non-REI provider submits for REI procedure? Specifically, could an ob-gyn submit for 58970 the same as an REI? I know with PAs/NPs there are certain modifiers which reflect less receivables for their education
Posted
Mar 28, 2022
My clinic is looking into implementing Alpha-Fetoprotein (AFP) testing. I understand there is currently no CPT code listed for this testing as it is not considered medically necessary-is that correct? Also, if there is currently no CPT coding, what code would be used? And lastly, if there is no CPT coding then we cannot bill insurance so can we bill patients?
Posted
Apr 08, 2022
Can you provide some information related to ovarian drilling that would assist non-physician administration (coders, billers) understand what the term means and how it may be billed?
Posted
Mar 28, 2022
Physicians at our practice are placing a stitch and dilating the cervix after egg retrievals for those patients that have cervical stenosis. Would you bill that in addition to the egg retrieval procedure and bill as unlisted? Here is an example of how it is documented. Thank you for your help!
“2-0 Vicryl stitch placed on anterior lip of cervix and cervix dilated with Pratt dilators. Speculum was removed.”
Posted
Feb 05, 2021
If the patient is undergoing ultrasound tracking visits for fertility preservation, what I ICD-10 code do you use for the monitoring?
Posted
Mar 28, 2022
I was reviewing your Coding Corner information to find a definitive diagnosis for IUI procedures. I am seeking clarification regarding which diagnosis is the most appropriate.
When a patient comes in for an IUI, what is the most appropriate diagnosis code?
Posted
Mar 03, 2021
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?
Posted
Mar 04, 2021
The Z31.41 is or is not the correct code to use for diagnostic testing of an infertile couple? And If so can if be used as the primary and only code?
Posted
Mar 08, 2021
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.
Posted
Feb 05, 2021
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.
Posted
Feb 05, 2021
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?
Posted
Feb 05, 2021
Our physicians are going to start doing an Endometrial Receptivity Analysis. Do you know the appropriate CPT code that should be used?
Posted
Mar 03, 2021
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?
Posted
Mar 08, 2021
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?
Posted
Mar 28, 2022
Can our office charge outside monitoring patients a flat fee to be seen? The patients are under the care of another physician, but we are performing an ultrasound and bloodwork. Do we have to bill the insurance if they are coming to our office even though they are not being treated by our doctors?
Posted
Jan 29, 2021
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?
Posted
Mar 04, 2021
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.
Posted
Mar 04, 2021
Does ASRM have any guidance for how to bill for genetic counseling services provided by a genetic counselor?
Posted
Apr 08, 2022
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider like we would for a global plan? For example, if one provider saw the patient initially, set the plan, and ordered the cycle charges. Would we bill this whole cycle under that provider, or bill each line under the specific provider that performed the procedure (ex. the retrieval)?
Usually with other specialties, we would bill under the performing provider, is there an exemption for IVF? Is this like global cases that are billed for OB services?
Posted
Mar 02, 2021
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.
Posted
Mar 02, 2021
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.
Posted
Mar 02, 2021
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.
Posted
Mar 03, 2021
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.
Posted
Mar 04, 2021
What code is used for a nurse practitioner seeing a fertility patient for the first time?
Posted
Mar 28, 2022
I looked at the coding corner site and found the below info which I find helpful. However, I have a question that is not addressed. If the HSG is performed in our office and not at a facility and fluoroscopy is provided, but isn’t necessarily used for needle placement but to see the contrast and dye, 77002 would not be the correct code, would it? For the fluoroscopy piece, would 76496, unlisted fluoroscopic procedure, be more appropriate. The 74740 is for the radiologic supervision and interpretation but not for the fluoroscopic portion on an HSG. Thoughts? Is there another better fluoroscopic code that should be used?
Posted
Mar 03, 2021
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.
Posted
Mar 03, 2021
Do you have any information on how to code for intralipid infusions? Our NP has indicated on the billing slip 36410, 96367, J7050.
Posted
Mar 08, 2021
What ICD-10 codes apply to case rates?
Posted
Mar 08, 2021
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?
Posted
Mar 08, 2021
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?
Posted
Jan 15, 2021
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?
Posted
Apr 08, 2022
One of our clients received information from your website that a repeat limited transvaginal ultrasound should be billed with a limited pelvic ultrasound code (76857). I am wondering if someone could verify that this information is accurate and let us know what that guidance is based upon. The American College of Radiology differentiates the two types of studies in the 2006 Ultrasound Coding User’s Guide. “The pelvic ultrasound using a full bladder as a window to the pelvis and a transvaginal ultrasound using a vaginal probe as a window to the pelvis are separately coded procedures. A common practice is for ultrasound departments to begin with a pelvic ultrasound performed through a full bladder and to supplement the examination with a transvaginal ultrasound. When the transvaginal examination is used as the only technique, use 76830 for the procedure.”
76830 Ultrasound, transvaginal
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete
76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (e.g., for follicles)
Posted
Mar 03, 2021
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?
Posted
Mar 05, 2021
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?
Posted
Mar 05, 2021
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!!
Posted
Jan 14, 2021
Our group would like to know if others are billing an evaluation and management code for ultrasound and blood draw visits?
Posted
Jan 15, 2021
What is the correct diagnosis code to use on the follicle ultrasound (76857) for a patient who is undergoing frozen embryo transfer (FET)?
Posted
Jan 15, 2021
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?
Posted
Mar 04, 2021
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?
Posted
Mar 28, 2022
My boss has a few follow up questions about a non-REI board certified MD performing REI procedures. She is thinking about bringing an Ob-Gyn on board to assist. In anyone's experience, is it common for an MD to perform REI procedures if not their specialty? If the billing is the same, is it allowable for the non-REI to submit for REI procedures? I understand the credentials make the CPTs valid but in general, is this allowable? Thank you!
Posted
Feb 09, 2021
How do you code for an office hysteroscopy?
Posted
Mar 08, 2021
Should one bill oocyte aspiration as a bilateral procedure?
Posted
Mar 08, 2021
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?
Posted
Jan 29, 2021
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.
Posted
Jan 29, 2021
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?
Posted
Mar 05, 2021
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.
Posted
Mar 04, 2021
If a husband has had a vasectomy, does the sterilization code apply to the wife's visits?
Posted
Feb 05, 2021
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.
Posted
Mar 03, 2021
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?
Posted
Mar 08, 2021
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?
Posted
Feb 05, 2021
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?
Posted
Mar 03, 2021
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?
Posted
Mar 08, 2021
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.
Posted
Mar 04, 2021
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?
Posted
Mar 04, 2021
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.
Posted
Feb 09, 2021
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?
Posted
Mar 08, 2021
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?
Posted
Mar 04, 2021
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?
Posted
Mar 04, 2021
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.
Posted
Mar 03, 2021
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.
Posted
Feb 05, 2021
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.
Posted
Feb 05, 2021
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?
Posted
Mar 03, 2021
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?
Posted
Feb 05, 2021
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?
Posted
Mar 28, 2022
Can you please refer me to an unlisted management CPT code for fertility treatment?
Posted
Feb 05, 2021
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?
Posted
Feb 05, 2021
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.
Posted
Feb 05, 2021
How would you code for an ultrasound- guided transvaginal-transmyometrial test transfer of embryo catheter?
Posted
Feb 05, 2021
Is there any specific CPT code(s) for uterine sounding? (Referring to cannulating the cervix and “sounding” or measuring the uterine height)
Posted
Mar 28, 2022
We are being told that, as of this year, vitamin D level screening is not being covered by many insurers. We have a very high incidence of vitamin D deficiency in our patient population, with a majority (probably 70-80%) of our patients showing deficiency.
As you know, Vitamin D is important for overall health and has also been associated with reproductive health and miscarriage. If there is a deficiency in the patient’s history or if the level is low, we can use the code of vitamin D deficiency and the cost of the test will be covered by insurance. But insurers are not covering under the diagnosis of health care maintenance or fertility testing.
We strongly believe, and our medical literature supports, that we should be doing the testing. But insurers disagree. The cost of the test is $200. What do you recommend?
Posted
Mar 28, 2022
I am trying to understand better when to use the procreative management code vs the fertility preservation counseling and procedure codes.
Code for the following:
- A single female using donor IUI, or a lesbian couple using donor IUI
- A transgender female coming to bank sperm before transitioning
- A young professional women coming to bank eggs for social reasons
Posted
Mar 23, 2023
IVF cycle management refers to the care needed for each IVF cycle to review, discuss the treatment plan and phone calls made to physicians, nurses, and pharmacies. There is no specific code for cycle management, so many programs do not charge for this service. Some have used 99499, which is for unlisted E+M services; however, third-party payors are not likely to reimburse for this code.
Monitoring E&M
Evaluation and Management (E/M) services on the same day as office procedures should be reported only if the patient’s condition requires a significant, separately identifiable evaluation and management service. That E/M service should be above and beyond the usual pre- and post-procedural care. If the patient was evaluated by the nurse or physician on the same day as the venipuncture and/or ultrasound, and the E/M visit was appropriately documented, then the appropriate E&M service may be coded (with a -25 modifier on the E&M service). Likewise, if the patient comes back and sees the physician or nurse at a later time for discussion of the results of the test, the appropriate level of E&M may also be documented and coded on that date of service. Routine use of E/M codes with every follicular monitoring scan is not advised as there needs to be a medical necessity for the E/M service that was separately identifiable from the process of follicle monitoring.
Limited monitoring ultrasound CPT
The code for a comprehensive transvaginal pelvic ultrasound (76830) includes imaging of the uterus, fallopian tubes, ovaries and pelvic structures, as indicated. A follow-up ultrasound, whether the approach is transvaginal or transabdominal, is coded as 76857. This code describes a focused examination limited to the assessment of one or more elements, or re-evaluation of one or more pelvic abnormalities, previously demonstrated on ultrasound. This is the appropriate code for follicular monitoring and for a limited follow-up transvaginal ultrasound. A limited follow up transvaginal scan, such as for follicular monitoring or a cyst check, is simply reported as 76857, and no modifier necessary.
S4042 Management of ovulation induction (interpretation of diagnostic tests and studies, non face – to – face medical management of the patient), per cycle.
Monitoring by nurses CPT
99211 is a code for the evaluation and management of an established patient.
Key points for using this code include:
1. The presence of a physician is not required.
2. Typically five minutes are spent with the patient.
3. The presenting problem is typically minimal.
4. Some sort of E+M is required- limited assessment or decision-making must occur. For example, this would not be appropriate if the patient was coming to the office to pick up a sample jar to collect a semen sample at home.
5. The service must be separate from any other procedure that day. For example, collecting a urine sample from a patient that is being evaluated by the physician for a possible infection would be included the physician’s E+M coding.
6. Although the physician is not required to perform the service, the physician should be in the facility at the time of the service.
7. Documentation does not require any key components (like is found in codes 99212 through 99215). Instead, the visit should be documented, including why the visit was necessary and what was done. Some sort of limited assessment or decision-making should occur.
Having nursing staff meet with patients to discuss ultrasound findings is probably not acceptable to bill 99211 because interpretation of the ultrasound is often included in the CPT for performing the ultrasound.
This code requires a face-to-face encounter, a phone conversation is not billable. However, if the nurse meets with a patient to review how to give an injection, or evaluates a patient who has a sore site after an injection, those encounters may meet the criteria of 99211.
Infertility consult by nurse
Diagnosis codes (ICD-10-CM) and procedure codes (CPT) are the same for everyone! That includes nurse practitioners, PA’s, sonographers, nurse midwives, embryologists, etc. But, in order to bill, each provider will have a provider ID number. This identifies to the payer the name of whom is rendering the service. Nurse practitioners are usually reimbursed at a discount relative to what an M.D. would be paid.
Patient education
Education sessions are used by many IVF practitioners before patients begin their first cycle. When a physician provides an educational seminar in a group setting, one can report 99078. Educational seminars given by nursing personnel may be reported as 99071. Third party payers don’t reimburse well for either of these codes. Additionally, 99211 can be used for education services by non-physician staff. The only requirement to bill for this is that teaching is at least five minutes and the physician is in the office during the E/M service. Another option is to use an unlisted special services code: 99199. You can bill for this service, but you are likely to be reimbursed only by your self-paying patients. Lastly, some practices choose to bill the patient a fee for a group educational session, and to not bill insurance.
Telephone consult
There are specific guidelines for a telephone consultation; these guidelines are in the appendix of the CPT manual (published yearly by the AMA).A nurse phone call to provide the patient with results is not reimbursable as it is considered part of performing a test.
IVF counseling
All surgeries and procedures are valued by CMS with attention to the time and effort spent in routine pre-op and post-op care that pertains to that specific surgical procedure. When RVUs are assigned, the time devoted to reviewing and signing the consent form is included in that valuation. The time spent in going through the informed consent process for the oocyte retrieval (the only part of IVF that has RVU assigned to it) is bundled into the reimbursement for that procedure. However, the time spent going through the informed consent process for all other aspects of IVF is not included. A practitioner may bill for face-to-face time if time is spent with the patient making the decision for treatment with IVF, teaching about the IVF process, reviewing certain interventions (ICSI, PGT, etc.), and discussing the risks of IVF such as aneuploidy, multiple gestations, etc.
When programs bill IVF under a global fee, they traditionally apply a single fee to cover all services in a routine IVF cycle. Centers that bill with a global fee are typically not using CPT codes, so the rules of CPT may not apply.
Monitoring FET ICD
The correct diagnosis will depend on the patient’s history. Typically, it is an infertility diagnosis (N97.X) ---due to anovulation, male factor, uterine factor, cervical factor, etc. However, there may be a genetic diagnosis if there was a preconception genetic carrier status.
CPT US Embryo Transfer in Surgery Center
The Embryo transfer, intrauterine [CPT code 58974] only includes the actual performance of the transfer by the physician. This code does not include either the Preparation of embryo for transfer (any method) [CPT code 89255] or the ultrasound performed for guidance of the embryo transfer..
There is not a specific code for ultrasound guidance of the embryo transfer. However there are ultrasound codes that can be used for this procedure: 76705 Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up). This would be appropriate since an ultrasound of the uterus to guide the embryo transfer is an ultrasound of a single organ and therefore fits the definition.
76998 Ultrasonic guidance, intraoperative. This code is utilized in the operating room by the surgeon or ultrasonologist as per the ACRs Ultrasound Coding User’s Guide 2010. This may be the reason why the auditing company is recommending this more specific code. Either of these 2 codes could be used to describe the ultrasound guidance for the embryo transfer.
Infertility consult by nurse
Diagnosis codes (ICD-10-CM) and procedure codes (CPT) are the same for everyone! That includes nurse practitioners, PA’s, sonographers, nurse midwives, embryologists, etc. But, in order to bill, each provider will have a provider ID number. This identifies to the payer the name of whom is rendering the service. Nurse practitioners are usually reimbursed at a discount relative to what an M.D. would be paid.
Patient education
Education sessions are used by many IVF practitioners before patients begin their first cycle. When a physician provides an educational seminar in a group setting, one can report 99078. Educational seminars given by nursing personnel may be reported as 99071. Third party payers don’t reimburse well for either of these codes. Additionally, 99211 can be used for education services by non-physician staff. The only requirement to bill for this is that teaching is at least five minutes and the physician is in the office during the E/M service. Another option is to use an unlisted special services code: 99199. You can bill for this service, but you are likely to be reimbursed only by your self-paying patients. Lastly, some practices choose to bill the patient a fee for a group educational session, and to not bill insurance.
Telephone consult
There are specific guidelines for a telephone consultation; these guidelines are in the appendix of the CPT manual (published yearly by the AMA).A nurse phone call to provide the patient with results is not reimbursable as it is considered part of performing a test.
IVF counseling
All surgeries and procedures are valued by CMS with attention to the time and effort spent in routine pre-op and post-op care that pertains to that specific surgical procedure. When RVUs are assigned, the time devoted to reviewing and signing the consent form is included in that valuation. The time spent in going through the informed consent process for the oocyte retrieval (the only part of IVF that has RVU assigned to it) is bundled into the reimbursement for that procedure. However, the time spent going through the informed consent process for all other aspects of IVF is not included. A practitioner may bill for face-to-face time if time is spent with the patient making the decision for treatment with IVF, teaching about the IVF process, reviewing certain interventions (ICSI, PGT, etc.), and discussing the risks of IVF such as aneuploidy, multiple gestations, etc.
When programs bill IVF under a global fee, they traditionally apply a single fee to cover all services in a routine IVF cycle. Centers that bill with a global fee are typically not using CPT codes, so the rules of CPT may not apply.
IVF Facility Fees should be used for the cost of use of supplies and for in-office surgical procedures to maintain the surgical facility. This would include for facility costs of the outpatient procedures including IVF retrieval and embryo transfer.
1. Reusable supplies/equipment: the cost of use of these supplies are built into the charge for the procedure.
2. Disposable supplies: can be charged for if the individual unit cost is >$25 and use of the supply is documented in the chart.
3. Facility billing is limited to hospital-based clinics. Facility billing is the hospital’s technical charge for services provided in an outpatient department of a hospital. Unlike physician-based billing, facility costs are not built into the hospital reimbursement structure (ex: facilities/maintenance, lighting/electricity). The facility fee is essentially reimbursement for the use of hospital space and resources.
Posted
Mar 23, 2023
