IVF using donor egg or embryo

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Wake Forest, NC
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1st let me say I am more of a biller/collector than a coder, but I do have my CPC but this is beyond my scope of knowledge and any help is greatly appreciated. We bill for IVF for patients who have normal coverage using their own eggs/sperm, etc. no issue but it is when it comes to patients having to use donors due to poor egg quality, etc that we are having a issue, and I am new to this area and I am going by what I have been told by my manager that even if a patient has donor coverage there is no way to bill the services for the donor, such as ultrasounds, labs, etc., under the patient and there is no way to bill the IVF procedure to the insurance company using a donor egg/embryo, but the more I research it appears it can be done using S4023 and S4025 with specific Z codes which we are being told by UHC can be done and auth can be obtained thru Optum using these codes, but these are case rate codes right? I know we get auth via Aetna with these codes but then it is broken down into like 18 codes when we bill I believe and I do not do the billing for these so I am kind of operating in the dark here, I do the office, Ultrasounds, etc.. so that is why this is all new to me.. if anyone can shed some light on this would be great - thanks so much! Debbie
 

HKopanski

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Charleston, SC
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1st let me say I am more of a biller/collector than a coder, but I do have my CPC but this is beyond my scope of knowledge and any help is greatly appreciated. We bill for IVF for patients who have normal coverage using their own eggs/sperm, etc. no issue but it is when it comes to patients having to use donors due to poor egg quality, etc that we are having a issue, and I am new to this area and I am going by what I have been told by my manager that even if a patient has donor coverage there is no way to bill the services for the donor, such as ultrasounds, labs, etc., under the patient and there is no way to bill the IVF procedure to the insurance company using a donor egg/embryo, but the more I research it appears it can be done using S4023 and S4025 with specific Z codes which we are being told by UHC can be done and auth can be obtained thru Optum using these codes, but these are case rate codes right? I know we get auth via Aetna with these codes but then it is broken down into like 18 codes when we bill I believe and I do not do the billing for these so I am kind of operating in the dark here, I do the office, Ultrasounds, etc.. so that is why this is all new to me.. if anyone can shed some light on this would be great - thanks so much! Debbie
Hi Debbie, did you ever figure out how to bill donor services to the intended parent's insurance? I am currently having the same issue.
 

nielynco

Networker
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Guadalupita, NM
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Hi Debbie, did you ever figure out how to bill donor services to the intended parent's insurance? I am currently having the same issue.
1st let me say I am more of a biller/collector than a coder, but I do have my CPC but this is beyond my scope of knowledge and any help is greatly appreciated. We bill for IVF for patients who have normal coverage using their own eggs/sperm, etc. no issue but it is when it comes to patients having to use donors due to poor egg quality, etc that we are having a issue, and I am new to this area and I am going by what I have been told by my manager that even if a patient has donor coverage there is no way to bill the services for the donor, such as ultrasounds, labs, etc., under the patient and there is no way to bill the IVF procedure to the insurance company using a donor egg/embryo, but the more I research it appears it can be done using S4023 and S4025 with specific Z codes which we are being told by UHC can be done and auth can be obtained thru Optum using these codes, but these are case rate codes right? I know we get auth via Aetna with these codes but then it is broken down into like 18 codes when we bill I believe and I do not do the billing for these so I am kind of operating in the dark here, I do the office, Ultrasounds, etc.. so that is why this is all new to me.. if anyone can shed some light on this would be great - thanks so much! Debbie

1st let me say I am more of a biller/collector than a coder, but I do have my CPC but this is beyond my scope of knowledge and any help is greatly appreciated. We bill for IVF for patients who have normal coverage using their own eggs/sperm, etc. no issue but it is when it comes to patients having to use donors due to poor egg quality, etc that we are having a issue, and I am new to this area and I am going by what I have been told by my manager that even if a patient has donor coverage there is no way to bill the services for the donor, such as ultrasounds, labs, etc., under the patient and there is no way to bill the IVF procedure to the insurance company using a donor egg/embryo, but the more I research it appears it can be done using S4023 and S4025 with specific Z codes which we are being told by UHC can be done and auth can be obtained thru Optum using these codes, but these are case rate codes right? I know we get auth via Aetna with these codes but then it is broken down into like 18 codes when we bill I believe and I do not do the billing for these so I am kind of operating in the dark here, I do the office, Ultrasounds, etc.. so that is why this is all new to me.. if anyone can shed some light on this would be great - thanks so much! Debbie
I would strongly recommend that you contact ASRM for advice on this issue. They have a coding page (https://www.asrm.org/resources/coding/coding-qa/coding-corner/claim-form-for-donor-egg-retrieval/) which you can access if your providers are a member (similar to one that ACOG has developed). It has been many years since I have done any infertility coding/billing so their take would be up to date. Or you can wait to see if anyone who does IVF billing has an answer for you. I suspect the answer will be payer specific, and while the S codes are certainly available, they may not be recognized by many payers (they were developed by BCBS for their billing purposes). And of course if the case rate applies, you can list all the codes you want, but will only be paid a one-time fee for the case rate. I hope this helps.
 
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