Posted
March 18,
2013
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?
Posted
January 28,
2013
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?
Posted
December 10,
2012
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?
Posted
November 29,
2012
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
November 20,
2012
My doctor wants to do a mock transfer prior to an actual IVF procedure using a frozen donor oocyte. My insurance is willing to pay for the procedure. However, I do not have the CPT to file with my insurance because my doctor's office billing department said that there is no CPT code for such a procedure because it is done in preparation for a donor egg bank cycle. Is this correct? Is there a CPT code for this procedure?
Posted
July 23,
2012
We are seeing a lot of patients coming in to just discuss the fertility options available to them. They are not necessarily infertile. We have been using ICD9 code V26.89. Do you recommend that we utilize any other ICD 9 codes? If so, which ones?
Posted
May 25,
2012
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 V26.49 (other procreative management, counseling and advice) or sometimes we use V65.49 (other specified counseling). Recently, BCBS started denying anything that we bill with these two codes because they consider them “routine”. Do you know of any other ICD-9 we can use when the patient comes in for consults/follow ups?
Posted
May 25,
2012
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?
Posted
May 21,
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.
Posted
April 5,
2012
How should I bill for 3-D sonography?
Posted
March 19,
2012
What is the code for frozen embryo transport?
Posted
October 25,
2011
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.
Posted
October 25,
2011
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.
Posted
October 25,
2011
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 302.50, 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 259.9, 302.50. 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
September 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 that is valid at the time the service is provided. Therefore, physicians must cease using discontinued codes for services after the new codes become effective October 1, 2011.
Posted
May 18,
2010
Several years ago, I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of 614.1 (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?
Posted
May 18,
2010
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 any where that these are bundled procedures. Please advise.
Posted
May 18,
2010
Is there a list of RVUs for embryology and andrology laboratory procedures, and if so, where can it be found?
Posted
May 18,
2010
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?
Posted
December 3,
2009
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.
Posted
December 3,
2009
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 620.2 diagnosis if the patient will take that cycle off? There is not a need to put a secondary diagnosis code of 628.9, is there?
Posted
December 3,
2009
Our physicians have struggled with particular 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 628.9. There are very few patients who are not infertile but are actually RPL (629.81), and in their recurrent pregnancy loss work up, the only finding is progesterone deficiency. These patients will usually be prescribed Clomid to hopefully correct this deficiency and help a pregnancy last. With regard to the ovary checks and ultrasounds these patients have, what should their diagnosis code be -- 628.9 or 629.81? I am afraid if we bill it with a 629.81 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 629.81 and have not been able to conceive again, and in these cases when Clomid is prescribed, we feel it is appropriate to bill with a 628.9 diagnosis code.
Posted
December 3,
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.
Posted
September 29,
2009
What is the procedure code for IVF? I'm trying to find out if my insurance will cover the procedure.
Posted
September 29,
2009
My infertility doctors bill the 76830 transvaginal ultrasound every time they perform an ultrasound even when they are monitoring the patient’s follicle. Should they be billing 76857, Ultrasound pelvic limited or follow up (e.g. for follicles). The doctor states that they not only look at the follicles but also the endometrium. Their report states:
Endometrial Thickness (mm) 10.0
Number of follicles <10 mm
Number of follicles >12mm
Total # of measured follicles
All measured follicles
Posted
June 16,
2009
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.
Posted
June 16,
2009
New CPT Codes for 2008 Laparoscopic Total Hysterectomy
Posted
June 16,
2009
Is there a CPT Code for "Ovarian Drilling"?
Posted
June 16,
2009
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)?
Posted
June 16,
2009
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?
Posted
June 16,
2009
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?
Posted
June 16,
2009
How do I code for therapeutic donor insemination for an unmarried female with no known fertility issues except no partner?
Posted
June 16,
2009
What is the proper ICD-9 code to use for a patient undergoing artificial insemination purely for sex preselection?
Posted
June 16,
2009
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?
Posted
June 15,
2009
How do you code for Ultrasonography performed at the time of an embryo transfer?
Posted
June 15,
2009
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
June 15,
2009
How do you code for a hysterosalpingogram or saline hysterosonogram?
Posted
June 15,
2009
What code should be used for a vaginal probe ultrasound done to check for follicles during ovulation induction -- 76857 or 76830-52? 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
June 15,
2009
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
June 15,
2009
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?
Posted
June 15,
2009
Have any new codes been introduced for the lab portion of preimplantation genetic diagnosis (PGD)?
Posted
June 15,
2009
I am trying to identify the correct CPT code for preimplantation genetic diagnosis (PGD). Could you help?
Posted
June 15,
2009
Our clinic is just starting to do PGD. We currently are flying 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 air fare, hotel, eating expenses, and the embryologist’s professional charges and laboratory charges. We haven’t had to deal with a patient and insurance for this type of service before.
Posted
June 15,
2009
What is the correct ICD-9-CM Coding for screening tests performed by physicians treating infertility patients?
Posted
June 15,
2009
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.
Posted
June 15,
2009
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?
Posted
June 15,
2009
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
June 15,
2009
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
June 15,
2009
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
June 15,
2009
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 V26.4 (procreative management) as a primary code and 629.9 as a secondary code?
Posted
June 15,
2009
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
June 15,
2009
What code is used for a nurse practitioner seeing a fertility patient for the first time?
Posted
June 15,
2009
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
June 15,
2009
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?
Posted
June 15,
2009
Can a privately owned office facility dedicated to IVF services and embryology lab bill a facility fee to insurance companies?
Posted
June 12,
2009
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)?
Posted
June 12,
2009
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
June 12,
2009
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?
Posted
June 12,
2009
Is there another code other than V26.21 or V26.29 for pre-IVF testing that insurance will NOT deny?
Posted
June 12,
2009
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.
Posted
June 12,
2009
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?
Posted
June 12,
2009
First Trimester Ultrasound Denials
Posted
June 12,
2009
Excuse me, but I did that twice! Explain more about relative value units (RVU).
Posted
June 12,
2009
Our physicians do the retrograde semen analysis. What CPT/CPTs would you suggest we use?
Posted
June 12,
2009
There are two new codes and revisions were made to the existing semen analysis codes to clarify their intent. 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.
Posted
June 12,
2009
We frequently perform Strict Criteria Morphology alone (without semen analysis). What would be the appropriate code for that test?
Posted
June 12,
2009
If a husband has had a vasectomy, does the sterilization code apply to the wife's visits?
Posted
June 12,
2009
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?
Posted
June 12,
2009
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.
Posted
June 11,
2009
When our doctor does a paracentesis for a patient with ovarian stimulation, what would be the best CPT code to use? We are considering using 49080. Can this be used with 76942 when ultrasound guidance is used, or do we need to pick one or the other?
Posted
June 11,
2009
What is the code to use for COS (Controlled Ovarian Stimulation): managing the patients, dosing of HMG, etc.?
Posted
June 11,
2009
I need a CPT code for microsurgical epididymal sperm aspiration. Could you help?
Posted
June 11,
2009
I looked through the “Ob/Gyn Coding Manual” and have not found a code for a mock embryo transfer. How can I report this procedure?
Posted
June 11,
2009
Have CPT codes been established for Maturation In Vitro? If so, what are they?
Posted
June 11,
2009
The CPT coding info for ART labs you provide is very useful. Do you have information on endocrine lab testing -- specifically, CPT codes and typical reimbursement from third-party payers? Also, how does reimbursement for diagnostic endocrine testing differ from endocrine monitoring for the treatment cycle? Are there other diagnostic andrology procedure codes and reimbursement for tests such as the cervical mucus penetration test, etc., that you did not list in the "correct coding for lab procedures during ART cycle" publication?
Posted
June 11,
2009
One of the problems we are having is coding for the management cycle. Coding for insurance companies for in vitro fertilization is still quite new to us. Can you help?
Posted
June 11,
2009
Where can I find a list of the new codes for ART Laboratory procedures?
Posted
May 29,
2009
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.
Posted
May 29,
2009
Important new ICD-9 Diagnosis Codes for 2008 Patient Undergoing Assisted Reproductive Technology
Posted
May 29,
2009
What is the appropriate ICD-9 code for a surrogate carrier? Can you make a recommendation?
Posted
May 29,
2009
If a woman requires a gestational carrier, how is the gestational carrier coded? She is truly not a surrogate, just gestational.
Posted
May 29,
2009
Are we allowed to bill professional charges under the physician for the embryologist who performs the IVF laboratory services (ICSI, hatching, cultures)?
Posted
May 29,
2009
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.
Posted
May 29,
2009
Is there a code that can be used for donor sperm?
Posted
May 29,
2009
How do you submit billing when a patient has insurance coverage for donor egg retrieval? It also pays for medications (i.e., Antagon®, Repronex™, and Follistim® for the egg donor). What CPT codes should be used if an egg donor is used?
Posted
May 29,
2009
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?
Posted
May 28,
2009
I am writing in regards to this question, because I am interpreting this as though a provider should NOT be billing 89258 for cryopreservation of embryo & storage of embryo. Am I interpreting this correct? Or can a provider bill storage under this code, just with an increase fee? I came across your website because a friend is having a difficult time getting her provider to bill embryo storage because they state this code is for freezing only. And there is no appropriate code to use for storage. Can you please help with this situation?
Posted
May 28,
2009
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?
Posted
May 28,
2009
Does the insurance industry have a designated CPT code for the “cryopreservation and storage” of reproductive cells and tissue?
Posted
March 23,
2009
New ICD-9 codes for 2008: Natural family planning for contraceptive and procreative management.
Posted
March 22,
2009
I was wondering how to 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?