Pathology/Lab Coding Alert

Primary diagnosis ban continues.

Virtually nothing changes except the code numbers when you report the diagnosis for semen and sperm analysis under ICD-10 instead of ICD-9. 

No matter how straightforward the change, you’ll still need to be ready when the new code set goes into effect on Oct. 1, 2014. 

Transfer V26.2 to Z31.4

When the lab performs a semen or sperm procedure as part of an assisted reproductive technology (ART) treatment, the ordering clinician typically identifies ART as part of the reason for the test by reporting one of the following codes:

• V26.21 — Fertility testing 
• V26.22 — Aftercare following sterilization reversal

This code includes sperm count following sterilization reversal.

Once ICD-10 goes into effect, expect the clinician to report one of the following diagnosis codes instead:

• Z31.41 — Encounter for fertility testing
• Z31.42 — Aftercare following sterilization reversal

This code includes sperm count following sterilization reversal.

Caution: Medicare currently has edits in place that make the V26.2 codes unacceptable as a primary diagnosis for inpatient hospital admission. Expect that restriction to tighten when ICD-10 goes into effect, because the new code set identifies Z31.41 and Z31.42 as unacceptable for primary diagnosis under any circumstances. 

The ordering clinician may use a code such as 606.1 (Oligospermia) as a primary diagnosis. That code does not have a direct crosswalk to ICD-10, because N46.1 (Oligospermia) requires a fifth or sixth digit to distinguish the cause of the low sperm count.