Accurate Artificial Insemination and IVF Coding in 6 Easy Steps

Split IVF retrieval, transfer services to optimize reimbursement
Do you think your in-vitro fertilization (IVF) and artificial insemination claims are airtight? Not if you're billing all of the codes to the female's insurer. Splitting the charges based on gender may decrease denials and streamline your billing.

Complex treatment: An ob-gyn practice can perform intracervical inseminations, but if infertility problems lead a patient to a reproductive endocrinologist, the patient may require a more complicated intrauterine insemination or in-vitro fertilization, says Brad Hart, MS, CMPE, CPC, office administrator of Mid-Iowa Fertility PC and West Des Moines Ob-Gyn Associates in West Des Moines.

Both the intrauterine insemination and the in-vitro fertilization processes involve numerous visits and codes. The following checklist will help you assign the right code for some of the trickiest parts of these complex treatments.

Intrauterine Inseminations
1. Select 58323 or 89261 for sperm wash. You should report two codes if your endocrinologist performs an intrauterine insemination: 58322 (Artificial insemination; intrauterine), and either 58323 (Sperm washing for artificial insemination) or 89261 (Sperm isolation; complex prep [e.g., Percoll gradient, albumin gradient] for insemination or diagnosis with semen analysis).  

"Code 58323 is the sperm-wash code for physician offices, and 89261 is the sperm-wash code for high-complexity labs," says Hart, who gave a presentation titled "Infertility: Where Technology and Coding Meet" at the American Academy of Professional Coders' 2004 conference. A reproductive endocrinology practice with a high-complexity lab should most likely bill 89261, he says.

2. Link the correct diagnosis codes to male and female services. When the endocrinologist performs the female's insemination, link V26.1 (Artificial insemination) to 58322, Hart says. Code V26.1 can function as the primary diagnosis for that particular service, he says. You should then bill the cause of infertility (628.x, Infertility, female) as the secondary diagnosis.

If the female has the insemination because of her male partner's infertility, you should still report V26.1 as the primary diagnosis and then 628.8 (Infertility, female; of other specified origin) as the secondary diagnosis. In this case the "other specified origin" is the male, Hart says.

Another way: Depending on the payer, you may need to use the infertility code as the primary diagnosis and V26.1 as secondary. "We don't put the V code first because most health plans don't want a V code as primary," says Brenda Messick, CPC, business manager of Georgia Reproductive Specialists in Atlanta. "Contact your carriers to see what they want, but in most instances carriers will say supplemental codes should not be used as primary diagnoses."

Example: Your reproductive endocrinologist (RE) performs an intrauterine insemination on a female who is infertile due to a tubal blockage. You should report 58323 and link V26.1 as the primary diagnosis, with 628.2 (Infertility, female; of tubal [...]

- Published on 2004-05-20