Question Transgender Patients

Jessim929

Guru
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Now that transgenderism is becoming more and more common, is anyone having problems with getting certain claims paid?

Here's my case: I work for Urology, and one of my docs saw a fully post-op (per chart) male to female patient. HOWEVER, patient still had a prostate, which was enlarged and the primary focus of the visit, so BPH is the diagnosis used. Insurance rejected as not gender appropriate. Using the gender dysmorphia diagnosis on the claim did not help matters.

Same doctor has also recently done a bilat orchopexy on a patient in the midst of reassignment. I do not know if the insurance has paid or denied it yet, but if they have the patient as "female" and they're having testes removed, I can't imagine it being paid without appeal.

Is this just going to be a fact of life or what? I'd appreciate any insight.

Thanks!
 

cgaston

Expert
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what about adding Z87.890 "personal history of sex reassignment"? I doubt it will stop the denials but at least it helps paint the picture of the visit.
 
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