Wiki Identifies as question

[metzger130]

We had a patient come in for her yearly exam and it was denied by insurance because they have her as male. We find out that She identifies as a male and when registering with insurance put herself as male. We billed out our yearly gyn exam out and had her as female. In your demographic area for your patients what should the sex be, F or M? If anyone has a link to documentation I would like to see it also as the physicians will want to know what's going on if they start and see Male patients for a GYN exam.

Thank you!

 

[Cmama12]

Gender should be set to whatever the patient identifies as. A note can be put in the record - if they are undergoing gender reassignment, there is a dx for that can be added.

Use KX modifier - https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1877CP.pdf

These need to be forced to bypass the EMR edits for gender/dx or gender/procedure. I haven't dealt with any denials for these as of yet, but it should be appealed.