Every healthcare provider is familiar with the ICD-10-CM codes that are required for billing discharges and patient encounters. These codes mandate that each procedure performed and billed at an appointment must be related to a code's assigned diagnosis.
In the area of reproductive medicine, fewer billable ICD codes apply than would for a primary care provider. However, these codes can be tricky to use, given the ongoing transition from ICD-9 to ICD-10 and the addition of more details within coding in general. When you're processing patient paperwork, diagnosis codes should be as specific as possible. For example, the code N97 is for female infertility, but N97.2 indicates that the infertility is of uterine origin. Some main codes are not billable, but their sub-codes may be.
While there's not enough room to outline every important code to know in a single article, this quick guide will provide an overview of the most commonly used ICD-10-CM codes in reproductive medicine and endocrinology.
Z31: Encounter for Procreative Management
The Z31 code includes 25 subcategories, ranging from Z31.62 for fertility preservation counseling to Z31.5 for genetic counseling. Z31 is used to bill for the encounters themselves, including testing, sterilization reversals and aftercare.
N97: Female Infertility and N46: Male Infertility
The N97 category excludes hypopituitarism (E23.0) and Stein-Leventhal syndrome (E28.2), as well as incompetent cervix (N88.3). Under female infertility are five extended codes that allow the diagnosis to specify the origin of infertility, if known. N97.1, for instance, covers tubal conditions such as blockages or stenosis and stricture, while N97.9 covers infertility of an unspecified origin.
N46 excludes vasectomy status (Z98.52) and is broken down into 20 subcategories. This range allows the coder to specify a reason for infertility, but also provide the option of an "unspecified" code (N46.9).
N98: Complications Associated With Artificial Fertilization
This category includes six complications associated with artificial fertilization, such as ovarian hyperstimulation syndrome. The N98 category is classified under "noninflammatory disorders of female genital tract."
Codes for Social Determinants of Health (SDOH)
Codes for SDOH have been expanded so that providers can be more specific about social factors that may interfere with a patient's access to healthcare. Note that not all SDOH codes are billable, but they are still important to note within the patient's medical record.
- Z55 has been expanded to include specifics about seven potential problems related to education and literacy.
- Z56 now includes employment and unemployment status subcategories.
- Z59 includes 10 subcategories to allow physicians to document specific problems with housing or economic circumstances. Worries about losing housing or an inability to pay for prescriptions, utilities or child care may fall under these subcodes.
- Z60 describes seven factors related to a stressful social environment, such as perceived discrimination, social exclusion or adjustment to transitions.
Patients seeking infertility treatments may be under an unusual amount of personal and financial stress, so providers may want to pay special attention to these codes.
Resources for Coding Help
If your practice is having problems adjusting to ICD changes, organizations like the American Society for Reproductive Medicine (ASRM) offer some helpful resources. Although questions and answers are only available to paid members, ASRM publishes a coding corner where clinicians may submit ICD coding questions for advice.
Remember that your billing records can be an important indicator of the health of your practice. The Centers for Medicare and Medicaid Services (CMS) guide ICD-10 KPIs at a Glance can help private gynecology practices overcome hurdles to processing claims efficiently and correctly, and use coding records to assess their productivity.
A fertility practice gains a reputation for helping patients overcome fertility challenges, not for its coding victories. But coding is a key part of day-to-day operations. By practicing precise and timely billing and keeping up with yearly changes to ICD codes, your practice can better avoid errors and focus on the people you treat.
