Submitting female codes under a male patient in a donor cycle
We got a rejection from the clearinghouse for using a female diagnosis under a male patient. My previous manager stated that it has to be billed under the intended parent (IP) because the donor is not on the policy.
Our software vendor advised: "The first step is to confirm that it's supposed to be billed like this. At least one state BCBS is asking people to put the policy on the donor and submit the claim with the donor as the patient and a note in box 19 that they are an egg donor."
Is this correct? He also suggested we reach out to the payer to get something from them that we can forward to the clearinghouse but I am concerned that procuring something like that would be difficult.
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Coding Q&A
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Topic Resources
Submitting female codes under a male patient in a donor cycle
We got a rejection from the clearinghouse for using a female diagnosis under a male patient. View the Answer
Billing donor services to IP’s insurance
When an intended parent has donor coverage under their insurance, how do we bill the donor services to their insurance? View the Answer
Reimbursement for donor egg
My wife and I are going through a fertility treatment process, and we have purchased a donor egg out-of-pocket from a donor bank. View the Answer
Misconduct in third-party assisted reproductive technology by participants and nonmedical professionals or entities: an Ethics Committee opinion (2023)
In some instances, it is ethically permissible for the physician to either disclose material information to the affected party or to decline to provide or continue to provide care. View the Committee Opinion
Defining embryo donation: an Ethics Committee opinion (2023)
Gestational Carrier
I would like to confirm ASRM’s opinion on the best code to use for a gestational carrier cycle. View the Answer
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We have a same-sex male couple with insurance coverage for IVF. View the Answer
Donor Egg Infectious Disease Lab Screening
The issue we are experiencing is outside labs billing with Z11.3 are getting denials stating improper ICD-10 for the services billed. View the Answer
Donor Egg Lot Acquisition
What is the code for egg lot acquisition? View the Answer
Donor Eggs-Physical Exam
Is there a specific CPT code used for Donor Physical Exams or would a practice just bill using the appropriate E&M Code? View the Answer
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Donor Embryos
Could you give guidance for the correct ICD-10 code(s) to use when a patient is doing an Anonymous Donor Embryo Transfer cycle? View the Answer
Donor Screening
Is there a specific CPT code used for Donor Physical Exams or would a practice just bill using the appropriate E&M Code? View the Answer
Claim Form for Donor Egg Retrieval
What bill form is used of IVF donor egg retrieval? View the Answer
Coding For Donor Egg Retrieval For Male Intended Parent
In coding a donor-egg retrieval to bill to insurance under the male intended parent, would it be appropriate to use the Z31.83? View the Answer
