Ob-Gyn Coding Alert

Question: Codes 89280 and 89281 don’t have a National Correct Coding Initiative (NCCI) edit, but payers are denying these codes as “mutually exclusive.” Can we bill both codes?

Rhode Island Subscriber

Answer: You should report 89280 (Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes) or 89281 (... greater than 10 oocytes) based on the number of oocytes undergoing assisted fertilization under CPT^® guidelines, but not both. NCCI would not have this edit because Medicare never covers infertility procedures. But you should not bill these codes together, because they are mutually exclusive under their CPT^® definitions.

For example, your ob-gyn fertilized eight oocytes, so you should report 89280. If your ob-gyn fertilized 11 oocytes, you would report 89281 instead.