Ob-Gyn Coding Alert

Question: We see patients regarding fertility, so before we see the patients for their initial visit, the infertility benefits are checked with the insurance carrier. Many Infertility patients have underlying medical problems. Therefore, they need to be evaluated and tested before the actual infertility diagnosis is made. We have used the Z31.89 diagnosis (Procreative) together with the other medical problems the patient has to bill for their E/M visits. However, just recently BC/BS is denying claims for those patients that have just the basic coverage (testing and evaluation) in their policy. Would you please clarify if a procreative diagnosis is considered infertility? BC/BS is the only insurance carrier doing this right now.

North Carolina Subscriber

Answer: Instead of using Z31.89 (Encounter for other procreative management), you may need to use Z31.49 (Encounter for other procreative investigation and testing). You should use procreative codes when the patient is trying to get pregnant but this does not necessarily imply the patient is infertile.