Wiki Transgender Coding/Billing

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ginapcoder

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We are an OBGYN Clinic seeing patients for women's healthcare. My question is where would I find coding and billing information for the services we provide ie office visits, ultrasounds, endometrial biopsies, hysterectomies for our patients who have changed their gender with their insurance company to Male but still have uterus, tubes, and ovaries. My research has returned primarily workflows and coding for gender re-assignment procedures and this is not the case. Please help.
 
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From my anecdotal experience, a >10 years ago it was very difficult to even try to explain to the insurance company why you would be doing a gynecologic procedure on a male patient. You could call, write appeal letters, write more appeal letters, and still not receive payment. Currently, it is not so complicated. In fact, Medicare has instructed to use modifier -KX for exactly this situation. Most commercial carriers will reverse a denial on the first appeal letter if they do not acknowledge -KX for this situation. The use of 2ndary dx F64.0 and Z87.890 can also be helpful.
 
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Hello Question, i am working with a Group OBGYN and seems that they are seeing more transgender, does the KX to be used on the office visit and any other cpt/ hcpc codes i have a patient female but registered as male per notes wants a hysto, and provider coded Z12.4 office and pap, what would your suggestion 1.quire the provider 2 what DX best fits if they are not in identity crisis, per notes does not state. For a Transgender hope this make sense , thank anyone in advance
 
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rebecca lopez said:
Hello Question, i am working with a Group OBGYN and seems that they are seeing more transgender, does the KX to be used on the office visit and any other cpt/ hcpc codes i have a patient female but registered as male per notes wants a hysto, and provider coded Z12.4 office and pap, what would your suggestion 1.quire the provider 2 what DX best fits if they are not in identity crisis, per notes does not state. For a Transgender hope this make sense , thank anyone in advance
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Modfier KX should be used on all claims as well as a code from the ICD-10 code series F64.- as a secondary code if there a otherwise primary diagnosis for the visit. If the visit is strictly regarding hysterectomy consult for gender affirming surgery F64.- is used with KX as the modifier. As always recommend to check with individual payers but my organization as adopted this modifier and using F64.-- on all claims related to gender affirming care.
 
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