# transgender dx coding



## amexnikki23 (Jun 23, 2015)

Scenario: a transgender patient who identifies with and looks like a male, and marks his gender as "M" on his demo sheet but is still legally a female according to driver's license. For billing purposes, we bill under their legal gender of female. If that patient is here for a testosterone injection, and you were to use a diagnosis of "low T" or something of that nature, it is incorrect because the patient is still technically a female and could not possibly have "low T" -physiologically OR technically. Therefore, claim is denied (unless insurance has coverage for transgender related services, which is really not the point of this post, please read on...). 

New Scenario: same patient gets his legal ID and gender marker changed to "M" and now is considered legally to be a male. Since this person is a male in the eyes of the government, he is no longer required to be reported a transgender (or is he?) and since, as a male, he produces no testosterone because of his internal make-up, he can now technically be diagnosed with a testosterone deficiency, and hence, billed to the insurance as a male receiving testosterone injections.  All thoughts and opinions welcome!


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## twinpw (Oct 17, 2016)

amexnikki23, coding Trangender is a specialty of it's own. It is correct to register the  pt under his legal birth certificate until it is legally changed.  Also ask the pt if his insurance has them listed as male of female, since the insurance will be paying on the claim. Second, use the KX modifier. This lets the insurance company know that a code that does not match gender is not an error, but allowed in this case. I use it a lot in transgender coding. It is not transgender exclusive, but a commonly know modifier for transgender coding. As for the testosterone injection, link it to the F64.1 code (Insurance companies deny the F64.9 code. Also the code may change to F64.0 with October 1, 2016-17 new guidelines). In the second senerio, still use the F64.1 code to support the need for the drug. Hope all this info helps, Pam


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