Pathology/Lab Coding Alert

Account for each step in cases that may span years.

To establish a healthy pregnancy, infertility treatment progresses from diagnosing the cause to performing various interventions involving gamete and embryo manipulation.

Almost every step of the way requires lab procedures. Read on for a look at many of the codes you may encounter, presented in the sequence typically performed over the course of assisted reproduction technology (ART) cases rather than the CPT^® listing sequence.

Assess Causes of Infertility

The CPT^® Reproductive Medicine Procedures section (89250-89398) includes a host of codes describing semen evaluation (89300-89322 [Semen analysis …]) for factors such as volume, count, and motility. Notice that you may need to use G0027 (Semen analysis; presence and/or motility of sperm excluding Huhner) instead of 89300 (Semen analysis; presence and/or motility of sperm including Huhner test (post coital)) if the test does not include the postcoital Huhner evaluation.

Your lab may also use more specific codes for sperm evaluation (89329-89331 [Sperm evaluation …]) or 88125 (Cytopathology, forensic (eg, sperm)). To diagnose infertility due to sperm antibodies present in semen or female serum, the lab may perform 89325 (Sperm antibodies).

You should also be familiar with this Proprietary Laboratory Analyses (PLA) code 0255U (Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score) if your lab performs this test.

Lab tests for female fertility may include blood tests for hormone levels such as 83001 (Gonadotropin; follicle stimulating hormone (FSH)), 82670 (Estradiol; total), 84144 (Progesterone), or 82166 (Anti-mullerian hormone (AMH)).

If it becomes appropriate to proceed to an ART process, lab work will be involved every step of the way. Here are some of the relevant codes and an explanation of when to use them.

Report Gamete Retrieval

For ART processes such as in vitro insemination (IVI) or in vitro fertilization (IVF), the initial work your lab may perform is to identify and isolate sperm and/or egg(s) (oocyte).

Following needle-guided retrieval from the ovarian follicles, the lab will identify and isolate eggs, which you should report as 89254 (Oocyte identification from follicular fluid).

Lab procedures for sperm isolation include the following codes:

• 89260-89261 (Sperm isolation; …) for simple or complex isolation methods from semen
• 89257 (Sperm identification from aspiration (other than seminal fluid))
• 89264 (Sperm identification from testis tissue, fresh or cryopreserved)

Capture Preservation, Storage, and Thawing

Whether the ART procedure involves freezing, storing, and later thawing of eggs, sperm, or fertilized eggs (embryos), CPT^® provides a host of codes you need to know, including:

• 89258-89259 (Cryopreservation; …) for embryo(s) or sperm, respectively
• 89335 (Cryopreservation, reproductive tissue, testicular)
• 89337 (Cryopreservation, mature oocyte(s))

Storing the frozen tissue requires using one of these codes:

• 89342 (Storage (per year); embryo(s))
• 89343 (… sperm/semen)
• 89344 (… reproductive tissue, testicular/ovarian)
• 89346 (… oocyte(s))

When the time comes to use stored tissue, the lab reports thawing the material with one of the following codes:

• 89352 (Thawing of cryopreserved; embryo(s))
• 89353 (… sperm/semen, each aliquot)
• 89354 (… reproductive tissue, testicular/ovarian)
• 89356 (… oocyte(s), each aliquot)

Document In Vitro Fertilization

Whether using fresh or previously cryopreserved sperm or oocytes, CPT^® provides specific codes to describe the fertilization procedures.

For fertilization that allows for natural sperm penetration of the oocyte by simply placing them together in a lab dish, turn to 89268 (Insemination of oocytes).

If the lab uses more active measures to fertilize the egg(s), such as intracytoplamic sperm injection, you have two codes to choose from based on the number of oocytes: 89280 (Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes) or 89281 (… greater than 10 oocytes).

List Culture or Other Preparation Measures

Labs may culture eggs or embryos for IVF or execute other procedures to facilitate successful embryo transfer. When they do, you’ll turn to the following codes to describe that work:

• 89250 (Culture of oocyte(s)/embryo(s), less than 4 days). Use this code to describe oocyte or embryo culture of less than four days (including insemination day) using fresh or previously cryopreserved tissue.
• 89251 (… with co-culture of oocyte(s)/embryos). This code includes all the work of 88250 plus an additional co-culture with feeder cells from other sources such as tubal or endometrial tissue.
• 89272 (Extended culture of oocyte(s)/embryo(s), 4-7 days). Use this code in addition to 89250 or 89251 for continuing the culture through day four or up to seven days.
• 89253 (Assisted embryo hatching, microtechniques (any method)). Use this code if the lab uses any microtechniques, such as laser, mechanical, or chemical measures, to assist in hatching an embryo from the zona pellucida.
• 89255 (Preparation of embryo for transfer (any method))
• 89290 (Biopsy, Oocyte Polar Body or Embryo Blastomere, Microtechnique (for Preimplantation Genetic Diagnosis); Less than or Equal to 5 Embryos) or 89291 (… greater than 5 embryos). You’ll use the appropriate code, based on the number of embryos, to describe biopsy of the polar body, trophectoderm, or blastomere. The biopsy provides material for preimplantation genetic diagnosis of the embryos.
• 89398 (Unlisted reproductive medicine laboratory procedure)

Don’t Miss Genetic Testing

Several PLA codes are available to describe genetic testing to optimize ART outcomes. PLA codes apply to only one unique lab test made by a specific manufacturer or performed by a specific lab.

For the specific test to assess endometrial receptivity for implantation, you may use 0253U (Reproductive medicine (endometrial receptivity analysis), RNA gene expression profile, 238 genes by next-generation sequencing, endometrial tissue, predictive algorithm reported as endometrial window of implantation (eg, pre-receptive, receptive, post-receptive))

For various genetic tests to evaluate embryos before implantation, you may turn to one of the following codes:

• 0254U (Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using embryonic DNA genomic sequence analysis for aneuploidy, and a mitochondrial DNA score in euploid embryos, results reported as normal (euploidy), monosomy, trisomy, or partial deletion/duplication, mosaicism, and segmental aneuploidy, per embryo tested)
• 0552U (Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when possible, targeted mutation analysis for known familial variant, reported as low-risk or high-risk for familial genetic disorder)
• 0553U (Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial DNA score, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, or mosaic, per embryo tested)
• 0554U (Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality control, results reported as normal (euploidy), monosomy, trisomy, segmental aneuploidy, triploid, haploid, or mosaic, with quality control results reported as contamination detected or inconsistent cohort when applicable, per embryo tested)
• 0555U (Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality control, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, triploid, haploid, or mosaic, with quality control results reported as contamination detected or inconsistent cohort when applicable, per embryo tested).

Ellen Garver, BS, BA, Contributing Writer