Wiki Testosterone inj for a female

[VSMichael]

I have a female patient who has been getting testosterone injections for several years. Medicare has always reimbursed. The last claim I submitted was denied with Medicare stating CO-7, "revenue/procedure code is inconsistent with patient's gender." I understand that, however, Medicare has been paying in the past. The claims have all been submitted using the same DX codes and CPT codes. Am I supposed to be using a modifier? I haven't used one in the past. Please Advise. Thank you!

 

[tcowboys07]

Without knowing what diagnosis you are using no one can answer your question. Is the reason for the injection because of transgender? If so, make sure it is listed as the dx. Also, you should append a modifier 25 to the e&m for the injection as injections are not considered to be a part of evaluation and management.