Wiki Z79.890 Hormone Replacement Therapy(Postmenopausal) Gender Issue

[jcroly]

I work for an insurance company and I'm seeing this code submitted on claims for males. Any thoughts as to why? Poor coding and misuse? Used for conditions other than postmenopausal like testosterone depletion? Let me know your thoughts why this would be justified for males.

 

[MrsTwinsMommy09]

Hopefully, you are not seeing this come to you as a principal Dx or a stand alone Dx. It should be used with an additional code to give some background on the reasoning for it. However in scouring the ICD-10 book and online research I am also having a difficult time locating a code that is purely for male replacement hormones. You are correct that the Z79.890 is purely a female related code. The best code that I could think to use for the male hormone therapy would be the Z79.899 (Other long term (current) drug therapy, with a supporting Dx. Hope this helps!

 

[DedertE]

I noticed in the optum360 books and on AAPC Coder, the symbol for female specific diagnosis is not attached. With the (postmenopausal) at the end of the description makes it seem like it should be. Very confusing.

 

[rbailey73]

Hopefully, you are not seeing this come to you as a principal Dx or a stand alone Dx. It should be used with an additional code to give some background on the reasoning for it. However in scouring the ICD-10 book and online research I am also having a difficult time locating a code that is purely for male replacement hormones. You are correct that the Z79.890 is purely a female related code. The best code that I could think to use for the male hormone therapy would be the Z79.899 (Other long term (current) drug therapy, with a supporting Dx. Hope this helps!

I have been receiving denials for this code as well, and no where can I find any literature that this is gender specific. Our coding team codes this when the patient is on thyroid medication and based on what I read, that is appropriate. I wonder how this code got boxed in to a female only dx code. I would appreciate any direction anyone has for this.

 

[dkhollins05]

Could someone please provide documentation from CMS confirming that Z79.890 is no longer a gender-specific code? I’ve found references on other websites, but I need official proof from CMS.gov to implement changes in our system. I believe these changes were made in 2017. Thank you!

 

[sls314]

Could someone please provide documentation from CMS confirming that Z79.890 is no longer a gender-specific code? I’ve found references on other websites, but I need official proof from CMS.gov to implement changes in our system. I believe these changes were made in 2017. Thank you!

I think it's just the change in the code description that was effective 10/1/2017.

The code description used to be "Hormone Replacement Therapy (postmenopausal)". Effective 10/1/2017, the word postmenopausal was dropped and now the description of the code is just Hormone Replacement Therapy.