Infertility Diagnosing

Our practice has 5 OB/Gyns who have recently been seeing patient's for infertility. We are running into huge problems because the providers know that most insurances do NOT consider infertility treatment medically necessary so they using other underlying conditions as primary diagnosis assignment. I have look in the ICD-9 Guidelines for Coding and Reporting but can't find anything specific to infertility codes (628.0-628.9 or 606.0-606.9). Does anyone out there have any literature on infertility diagnosising etc. Thanks all.

re: Infertility Diagnosing

If your physician is evaluating the patient to find the cause of her infertility, you are in the testing or counseling phase, and you should use V26.21 (Fertility testing) or V26.49 (Other procreative management counseling and advice).
You should report 628.x (Infertility, female) only when the ob-gyn has confirmed the patient is infertile and knows the cause. If your ob-gyn knows the patient is infertile and does not know the cause, you could use 628.9 (… of unspecified origin).

re: Infertility Diagnosing

Awesome. Here's an example just to be sure I have it down correctly... provider knows patient has PCOS (256.4) and this is why the patient is infertile... I would use the diagnosis code of 628.0 - Infertility associated with anovulation and the use the code 256.4 as additional code? Not 256.4 as the primary and then 628.0 as secondary, right?

re: Infertility Diagnosing

I would code, 628.8 (infertility other specified origin) prime and 256.4 (PCOS) 2ndary.