Wiki Transgender Pregnancy

[bonnienorth55]

Has anyone ever had to code for a transgender pregnancy? The patient is Female to Male. I see CMS rules state to attach modifier KX to the delivery code but I'm having a hard time finding much out there specifically about this scenario. Any insight would be greatly appreciated! Wondering if anyone has had to code for this, if they ran into issues getting their claims paid with the gender conflicting with those gender-specific code sets.

Edit: I just received some updated info that this patient has not had a reassignment surgery. They legally changed their gender to "Male" so I'm not sure if that would affect things?

Thank you!

 

[csperoni]

I've never needed to code a transgender pregnancy, but have needed to code several transgender (F2M) gyn visits, procedures and surgeries. Modifier KX usually results in correct processing by the insurance carrier. If it does not, then an appeal/explanation letter does.
I will say 15 years ago, it was a lot harder and required more effort to get these claims paid as the insurances didn't really have a system in place for patients that didn't fit the pre-defined boxes. These days, the insurance companies have developed a system and KX overrides those gender conflicts.

 

[bonnienorth55]

I've never needed to code a transgender pregnancy, but have needed to code several transgender (F2M) gyn visits, procedures and surgeries. Modifier KX usually results in correct processing by the insurance carrier. If it does not, then an appeal/explanation letter does.
I will say 15 years ago, it was a lot harder and required more effort to get these claims paid as the insurances didn't really have a system in place for patients that didn't fit the pre-defined boxes. These days, the insurance companies have developed a system and KX overrides those gender conflicts.

Thank you for your response! I was not alerted for some reason and am just now seeing this. I did find info on the KX mod and attached that so we shall see how it's processed. That's good to know an appeal letter usually takes care of it. Thank you again!