Wiki Gender Affirming procedural coding education

tloeb

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Hi All,
I have been tasked with coding for gender affirming procedures. Does know of any educational material or presentations? I currently code for OB/GYN and Gyn Onc so some of these procedures are easy - hysterectomies etc, however, the plastic procedures are much more intimidating without the coding experience. I have searched on line for education but am coming up short. I do have material from WPATH that is helpful but looking for anything else that may exist.

Thank you!
 
I would look up your payers resources most plans if you google Aetna Gender Affirming Guidelines or BCBS it will give you resources on what they allow and don't allow. I think that different payers set up different rules in this case I would defer to those sites to guide you in some ways.
 

Hello Tloeb,♀️♂️⚧

Here is data from Medicare - Billing and Coding: Gender Reassignment Services for Gender Dysphoria A53793​

Reference :NCD - Gender Dysphoria and Gender Reassignment Surgery (140.9)

This are some CPT codes related to transgender surgery of penis, vagina, face and breast reconstruction​

Possible Dx code block F64,N64, Z98.52, F52, N53,N48​

Here are some of the main CPT codes ....​

Remove penis CPT 54125 - and CPT 55970 male to female, CPT 19325 Breast implants for humans​

Remove vagina surgery 57292 ,57281, 57335 and female to male CPT 55980 but review site to get just of all surgery and care involved. I learned that some transgender males do not get prostate removed thus still need prostate check every year.​

Listed below are medical procedures GD humans may use......​

  • Breast reconstruction (e.g., mastectomy) - removal of breast
  • Hysterectomy - removal of uterus
  • Salpingo-oophorectomy - removal of fallopian tubes and ovaries
  • Vaginectomy - removal of vagina
  • Vulvectomy - removal of vulva
  • Metoidioplasty - creation of micro-penis, using clitoris
  • Phalloplasty - creation of penis, with or without urethra
  • Urethroplasty - creation of urethra within the penis
  • Scrotoplasty - creation of scrotum
  • Testicular prostheses - implantation of artificial testes
  • Removal of penis
  • Liposuction: removal of fat
  • Rhinoplasty: reshaping of nose
  • Rhytidectomy: face lift
  • Blepharoplasty: removal of redundant skin of upper and/or lower eyelids and protruding periorbital fat
  • Hair removal/ hair transplantation
  • Facial feminizing (e.g., facial bone reduction)
  • Chin augmentation: reshaping or enhancing the size of the chin
  • Collagen injections
  • Lip reduction/enhancement: decreasing/enlarging lip size
  • Cricothyroid approximation: voice modification that raises the vocal pitch by simulating contractions of the cricothyroid muscle with sutures

Well hope I helped you :)

Lady T​

 
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