IVF coverage denied for Z31.83 diagnosis code
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000) but our insurer keeps denying it due to an exclusion of Z31.83 diagnosis code. The insurer does cover the various IVF CPT codes but the one diagnosis code associated with the treatment they won't cover and therefore refuse to cover infertility treatments.
My wife has stage 4 endometriosis and hydrosalpinx. She had surgery to have her tubes repaired/drained but the damage was so great that the surgeon could only remove one tube as he "couldn't discern her anatomy." We subsequently went to a specialist in another state who performed robotic-assisted surgery to remove her other tube and "clean up" her lower abdomen due to significant adhesions and remove endometrioid cysts.
On one hand, the fertility clinic says Z31.83 is the only diagnosis code that can be used for the actual treatment (i.e., embryo transfer), however the insurer won't cover it and is telling the clinic to use another diagnostic code.
My wife has stage 4 endometriosis and hydrosalpinx. She had surgery to have her tubes repaired/drained but the damage was so great that the surgeon could only remove one tube as he "couldn't discern her anatomy." We subsequently went to a specialist in another state who performed robotic-assisted surgery to remove her other tube and "clean up" her lower abdomen due to significant adhesions and remove endometrioid cysts.
On one hand, the fertility clinic says Z31.83 is the only diagnosis code that can be used for the actual treatment (i.e., embryo transfer), however the insurer won't cover it and is telling the clinic to use another diagnostic code.
Login now to view this Coding information. Coding Resources are available to ASRM Members only.
If you are not an ASRM member and would like to be, visit the Membership Tab above.
Coding Q&A
View more Coding Q&A in this category
Guidance for coding limited or follow-up ultrasounds used during an IVF Cycle
I am a coder for a Reproductive Endocrinologist's office and am looking for some guidelines on limited or follow-up ultrasounds used during an IVF Cycle.
Shipping of frozen embryos
I have some infertility coverage, under which my insurance said they will cover frozen embryo shipping/transport from one facility to another.
Measurements to report with ultrasound codes
Are there clear guidelines as to what measurements are required in order to bill for each type of ultrasound?
Exclusion of IVF services due to Z31.83
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000).Coding Corner
Coding Corner is segmented into the following sections. Click an image below to view questions and answers in that section.
More Resources
ASRM Academy on the Go
ASRM MAC Tool 2021
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.
Practice Guidance
EMR Shared Phrases/Template Library
This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.
ASRM Practice Documents
These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.
ASRM Ethics Opinions
Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Practice Guidance
Coding Corner Q & A
The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.
Practice Guidance
COVID-19 Resources
A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.
Patient Resources
ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.
Topic Resources
View more on the topic of endometriosis
Endometriosis
March is Endometriosis Awareness Month! We've combed our resources and compiled a list of our Practice Documents, Patient Fact Sheets, and more on endometriosis. View endometriosis resources
Journal Club Global: Actualidad En Tratamientos De Fertilidad Para Pacientes Con Endometriosis
Live in Spanish from the 2024 Peruvian Fertility Society Meeting - Lima, Peru View the Video
Exclusion of IVF services due to Z31.83
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000). View the Answer
Coding for aspiration of hydrosalpinx and endometrioma
Surgery was performed under anesthesia for Aspiration of right hydrosalpinx fluid and right endometrioma. Which CPT code would be best to use? View the Answer
Endometriosis and infertility: a committee opinion (2012)
Women with endometriosis typically present with pelvic pain, infertility, or an adnexal mass, and may require surgery. View the Committee Opinion
Medication Administration
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? View the Answer
Endometriosis and Infertility
For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
Excision Ovarian Endometrioma
What code is used for a laparoscopic excision of endometriosis and an ovarian excision of endometrioma with bilateral ureterolysis is performed. View the Answer
Endometriosis
A summary of common codes for Endometriosis compiled by the ASRM Coding Committee View the Coding Summary
Drs. Camran, Farr, and Ceana Nezhat Travel Scholar Award for Endometriosis
The objective of this award is to provide any trainee whose abstract submission focuses on endometriosis to expand their experience in the field. View the Award Information
Journal Club Global: Surgical management of endometriosis in women diagnosed with infertility (Spanish language)
Fertility and Sterility is excited to partner with our global professional colleagues to begin broadcasting regular Journal Club Global events in Spanish.
View the Video
Journal Club Global: Non-invasive Diagnosis of Endometriosis
One of the most exciting developments in the field of endometriosis is the push towards earlier and less invasive approaches to diagnosis. View the Video
Journal Club Global - Does the Endometrium Play a Major Role in Endometriosis-Associated Infertility
This will be a virtual event in the style of the "Fertile Battle" debate that took place at the 2019 SREI Fellows Symposium View the Video
Feb 2023: New Endometriosis and Isthmocele Codes
On June 9, 2022 the CDC issued updates to the ICD-10-CM code set reflecting more than 1,400 changes to your diagnosis coding options. View the Letter
Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
