• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Question Transgender Patients


Best answers
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.



Best answers
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.