Wiki Transgender patient

[debdebc]

Good Morning! I work in a billing office and there is a transgender patient that is a female but is being treated with male meds to eventually transition. The patient is still marked as "female" as requested but claims are denying due to the dx codes used for male treatment. How can this be overriden to go onto the insurance company to pay the claim? Thanks!

 

[danachock]

Hello debdebc,
I will assist you with what I know. A patient registered in your example is a female. I have to believe there are other possibly "male" gender related diagnosis codes also being added to the claim pertaining to the male gender. Adding the necessary KX modifier to those scenarios will move your claims along when registration information for a patient doesn't match the final diagnosis (opposite sex). Unless your internal system has OTHER "internal" edits in place to prevent this this very scenario. I would do some quick research and if appropriate from my example add KX modifier, when necessary, here (in my opinion).
Have a fantastic evening,
Dana

 

[csperoni]

Yes, I agree with @danachock about -KX. You may also want to consider an additional diagnosis of F64.0

https://www.acog.org/practice-management/coding/coding-library/coding-question-coding-for-the-transgender-process-services

 

[TThivierge]

Hi
Has the patient informed the insurance payer of his new name and gender change. This might affect the reason for denial if using certain name and full transition has not been record in the demographic documents or insurance company data files. Just a thought!
Lady T