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Male infertility Dx for female patient?

  1. Default Male infertility Dx for female patient?
    Medical Coding Books
    My provider posed a question regarding diagnosis coding for infertility. Our patient of course is female, and the cause of her infertility has been determined to be the spouse, or "MALE Infertility". The provider wants to code her treatment with "MALE Infertility"

    I have told the provider that using MALE infertility on our female pt's claims doesn't fly because 1) Claim edits knock out a female pt with a male diagnosis as incorrect, and
    2) our specialty doesn't deal with treating males.

    While I understand my provider's irritation (the problem really IS male infertility, and she documents as such) I won't put it on my claim to get denied out. Can anyone else tell me if they've addressed this issue in their practice? Thanks!

  2. #2
    Default
    Quote Originally Posted by ljhr@juno.com View Post
    My provider posed a question regarding diagnosis coding for infertility. Our patient of course is female, and the cause of her infertility has been determined to be the spouse, or "MALE Infertility". The provider wants to code her treatment with "MALE Infertility"

    I have told the provider that using MALE infertility on our female pt's claims doesn't fly because 1) Claim edits knock out a female pt with a male diagnosis as incorrect, and
    2) our specialty doesn't deal with treating males.

    While I understand my provider's irritation (the problem really IS male infertility, and she documents as such) I won't put it on my claim to get denied out. Can anyone else tell me if they've addressed this issue in their practice? Thanks!
    V71.89 - Observation for other specified suspected conditions
    "This category is to be used when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is found not to exist."

    You can't diagnose the patient with Male infertility; if she is not able to get pregnant because her partner is infertile, then she doesn't have a problem; her partner does. You can't vicariously treat her partner's inability to get her pregnant by treating her. Diagnoses are to be applied to the person they pertain to, so the man's infertility is the man's problem; having an infertile partner is not a diagnosable condition. You thought she might have been infertile, and after investigation, found that her reproductive system is functioning properly, so the only applicable diagnosis I can think of, would be the one I mentioned above. Hope that helps!

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    Brandi,
    Thank you SO MUCH for your eloquent and supported reply!!!
    Linda

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    As far as "Infertility" is concerned, in general male partner do not present or come as the initial encounter for the problem (to the male physician) and so invariably almost always the female partner is the first one to present to the GYN Physician for the infertility/Subfertility and they most often present as "a couple "presenting the couple's problem so much so the burdon of initial daignosis falls on the GYN.

    Moreover, in the infertility diagnosis encountered to a GYN, there are basically two major factors 'Female Factor' and 'Male Factor' of infertility. When a male factor is found to be a cause for the infertility, (even if there is a female factor contributing) , it has to be reported by the attending OBGYN Physician.
    It is not ethical to blame the female alone or pin point that she is the reason. Irrespective of whether there is a female factor or not, the male factor also should be investigated by the attending OBGYN Physician which is a tedious and time consuming/awaited work for the physician.
    So the Gyn Physician will report the male factor found or not found also.
    As per my openion,
    606.9 Male infertility (ie) Male Factor of infertility presenting to OBGYN) could be reported, the exact condition not specified.
    If not found, V code 71.x series can be reported along with the female factor whether found or not. but the physician will attach a detailed report of the work involved in arriving at the diagnosis.
    I feel it meets the ethical value as well as diagnostic value of Infertility, which is a combined diagnosis.
    When we address to the "Infertility ", it is always a couple related or concern/problem.
    In such scenario, the strict and stringent face value XX or XY presenting personality does not come to the surface.
    I hope this makes sense and matters both ethical, professional ( medical necessity), and coding point of view..
    Thank you .

  5. #5
    Default
    Quote Originally Posted by preserene View Post
    As far as "Infertility" is concerned, in general male partner do not present or come as the initial encounter for the problem (to the male physician) and so invariably almost always the female partner is the first one to present to the GYN Physician for the infertility/Subfertility and they most often present as "a couple "presenting the couple's problem so much so the burdon of initial daignosis falls on the GYN.

    Moreover, in the infertility diagnosis encountered to a GYN, there are basically two major factors 'Female Factor' and 'Male Factor' of infertility. When a male factor is found to be a cause for the infertility, (even if there is a female factor contributing) , it has to be reported by the attending OBGYN Physician.
    It is not ethical to blame the female alone or pin point that she is the reason. Irrespective of whether there is a female factor or not, the male factor also should be investigated by the attending OBGYN Physician which is a tedious and time consuming/awaited work for the physician.
    So the Gyn Physician will report the male factor found or not found also.
    As per my openion,
    606.9 Male infertility (ie) Male Factor of infertility presenting to OBGYN) could be reported, the exact condition not specified.
    If not found, V code 71.x series can be reported along with the female factor whether found or not. but the physician will attach a detailed report of the work involved in arriving at the diagnosis.
    I feel it meets the ethical value as well as diagnostic value of Infertility, which is a combined diagnosis.
    When we address to the "Infertility ", it is always a couple related or concern/problem.
    In such scenario, the strict and stringent face value XX or XY presenting personality does not come to the surface.
    I hope this makes sense and matters both ethical, professional ( medical necessity), and coding point of view..
    Thank you .
    I believe that the question was on how to properly code the encounter for the female patient's claim. Although patients may be evaluated, treated, and/or counseled as a couple, or in a group setting, ICD-9 codes must be selected to describe the problem, illness, or other reason for the encounter on an individual basis. In this instance, the patient in question is the female patient, who sought medical care to try and diagnose her suspected infertility.

    After testing, the doctor concluded that the female patient does not have a medical condition that is responsible for her inability to conceive; her male partner's infertility is the culprit. From a clinical standpoint, his contribution is significant to the situation; however, from a coding and reimbursement perspective, his infertility is irrelevant to this patient's claim.

    In order to describe the reason for the encounter without a problem to diagnose, an alternative ICD-9 code from the V-code section must be used. The category pertaining to Procreative management (V26) doesn't quite describe the situation, since it deals primarily with the testing and investigative stage of the process, which had already taken place at a previous encounter. This wasn't described as genetic counseling and/or testing, either. V26.49 (Other procreative management, counseling, and advice), or V26.89 (Other specified procreative management) may work to describe her encounter; however, I feel that V71.89 most accurately describes this particular patient's situation, since she was suspected to be infertile, and upon completion of testing, was found not to have such a condition.

    It would not be appropriate to assign a male gender-specific ICD-9 code to a female patient, since the problem described by the ICD-9 code does not afflict the patient. Consequently, claims edit systems will reject any claims billed with a mis-matched gender specific code, based on a "medically unlikely event" edit. I hope that clears up any confusion over the subject.

  6. Default
    100% percent agree with you Brandi. You CANNOT code the HUSBANDS/MALE PARTNER/WHOMEVER the male is. You can ONLY diagnose the female, which she does NOT have the problem, so I would definitely go with the V code. Just my two cents for whatever it is worth

  7. #7
    Talking
    Quote Originally Posted by eadun2000 View Post
    100% percent agree with you Brandi. You CANNOT code the HUSBANDS/MALE PARTNER/WHOMEVER the male is. You can ONLY diagnose the female, which she does NOT have the problem, so I would definitely go with the V code. Just my two cents for whatever it is worth
    LOL...I missed the word "spouse", and tried to be politically correct...(like they might read this and get offended)...I just realized I did that. I'm a dork. Ha!

  8. #8
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    I agree with Brandi also, while this may be a couples problem it is not the female's diagnosis, it is only the male's (spouuse's?). The diagnosis codes are for the patient's diagnosis and she does not have a diagnosis of male infertility, yet that is a problem for her to deal with, it is not her diagnosis to be afficted with.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    Quote Originally Posted by ljhr@juno.com View Post
    My provider posed a question regarding diagnosis coding for infertility. Our patient of course is female, and the cause of her infertility has been determined to be the spouse, or "MALE Infertility". The provider wants to code her treatment with "MALE Infertility"

    I have told the provider that using MALE infertility on our female pt's claims doesn't fly because 1) Claim edits knock out a female pt with a male diagnosis as incorrect, and
    2) our specialty doesn't deal with treating males.

    While I understand my provider's irritation (the problem really IS male infertility, and she documents as such) I won't put it on my claim to get denied out. Can anyone else tell me if they've addressed this issue in their practice? Thanks!
    The correct code for this is 628.8. Female infertility of other specified origin. The female is unable to get pregnant due to other origin which is the male factor issue.

  10. Default
    Quote Originally Posted by lbolton4 View Post
    The correct code for this is 628.8. Female infertility of other specified origin. The female is unable to get pregnant due to other origin which is the male factor issue.
    That is the code I would pick....

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