As far as "Infertility" is concerned, in general male partner do not present or come as the initial encounter for the problem (to the male physician) and so invariably almost always the female partner is the first one to present to the GYN Physician for the infertility/Subfertility and they most often present as "a couple "presenting the couple's problem so much so the burdon of initial daignosis falls on the GYN.
Moreover, in the infertility diagnosis encountered to a GYN, there are basically two major factors 'Female Factor' and 'Male Factor' of infertility. When a male factor is found to be a cause for the infertility, (even if there is a female factor contributing) , it has to be reported by the attending OBGYN Physician.
It is not ethical to blame the female alone or pin point that she is the reason. Irrespective of whether there is a female factor or not, the male factor also should be investigated by the attending OBGYN Physician which is a tedious and time consuming/awaited work for the physician.
So the Gyn Physician will report the male factor found or not found also.
As per my openion,
606.9 Male infertility (ie) Male Factor of infertility presenting to OBGYN) could be reported, the exact condition not specified.
If not found, V code 71.x series can be reported along with the female factor whether found or not. but the physician will attach a detailed report of the work involved in arriving at the diagnosis.
I feel it meets the ethical value as well as diagnostic value of Infertility, which is a combined diagnosis.
When we address to the "Infertility ", it is always a couple related or concern/problem.
In such scenario, the strict and stringent face value XX or XY presenting personality does not come to the surface.
I hope this makes sense and matters both ethical, professional ( medical necessity), and coding point of view..
Thank you .
I believe that the question was on how to properly code the encounter for
the female patient's claim. Although patients may be evaluated, treated, and/or counseled as a couple, or in a group setting, ICD-9 codes must be selected to describe the problem, illness, or other reason for the encounter
on an individual basis. In this instance, the patient in question is the female patient, who sought medical care to try and diagnose her suspected infertility.
After testing, the doctor concluded that the female patient does not have a medical condition that is responsible for her inability to conceive; her male partner's infertility is the culprit. From a clinical standpoint, his contribution is significant to the
situation; however, from a
coding and
reimbursement perspective, his infertility is irrelevant to this patient's claim.
In order to describe the reason for the encounter without a problem to diagnose, an alternative ICD-9 code from the V-code section must be used. The category pertaining to Procreative management (V26) doesn't quite describe the situation, since it deals primarily with the testing and investigative stage of the process, which had already taken place at a previous encounter. This wasn't described as genetic counseling and/or testing, either. V26.49 (Other procreative management, counseling, and advice), or V26.89 (Other specified procreative management)
may work to describe her encounter; however, I feel that V71.89 most accurately describes this particular patient's situation, since she was suspected to be infertile, and upon completion of testing, was found not to have such a condition.
It would
not be appropriate to assign a male gender-specific ICD-9 code to a female patient, since the problem described by the ICD-9 code does not afflict the patient. Consequently, claims edit systems will reject any claims billed with a mis-matched gender specific code, based on a "medically unlikely event" edit. I hope that clears up any confusion over the subject.
