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Dx- V26.49(infertility code):

  1. #1
    Question Dx- V26.49(infertility code):
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    I have seen 1 post that has similar scenario. Unfortunately, the claim was denied due to this dx code.

    I was billing for an E/M visits of 99213 and dx is V26.49. The doctor didn't specify the dx. The patient came in for an educational information about conception or getting pregnant. The insurance denied the diagnosis because it is an infertility code. Is there any way I could code it differently? When do I use V26.49? in this case, do I need to code first a dx that doesnt start with a V code? Although, patient has no chief of complaint.

    Add'l info: The patient with her husband came in to discuss how to conceive. The husband was curious if pt is pregnant. Doctor performs urine preg test and result came in, negative. They were trying to know how to get pregnant. So doctor gave a brief educational information about it for less than 20 mins.
    Last edited by coder103; 04-16-2011 at 11:24 AM.

  2. #2
    Columbia, MO
    99283 is a level 3 ER level, I agree that infertility is not an ER type diagnosis.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Quote Originally Posted by mitchellde View Post
    99283 is a level 3 ER level, I agree that infertility is not an ER type diagnosis.
    Thank you! I have corrected the typo error.......

  4. #4
    Columbia, MO
    your codes sound good add the V72.41 for the pregnancy test. There may be no benefits in the patient's policy for this.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thanks Debra! Your great help will help our claim go in the door for reconsideration. I want to help patient(s) that have been paying insurance with so much and they still end up paying for it. I tried not let pt pay, if possible. When problem arise like this w/o V72.41 only V26.49 should I consider letting the patient sign an ABN or does ABN only applied to medicare pt?

  6. Default Getting paid for infertility discussion
    The only infertility diagnosis codes are: V26.21, which can be used for any diagnostic testing. Use V26.29 - other investigation and testing for E&M codes where physician is discusisng possible causes of infertility, possible treatment plans, etc. If the patient has benefits for the diagnosis of infertility, these codes typically will pay.

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