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Thread: infertility V26.21

  1. #1

    Default infertility V26.21

    AAPC: Back to School
    Our infertility practice in IL is having a hard time coding pts who are diagnostic. The patients have come in from an OB/GYN office having been treated w/ Clomid. I am hoping someone can help clarify or agree that once a patient starts meds to treat the disease(in this case infertility) they can no longer use code V26.21--fertility testing. Unfortunately the OB/GYN's have gotten into the practice of giving out Clomid but not performing the dx tests first. Insurances w/ dx policies only will not cover these tests under 628.9 or unspecified infertility. Hoping someone can help clarify the use of V26.21 in these circumstances.

  2. #2


    V26.21 is used when a patient is undergoing testing to determine the cause of her infertility or if she is in fact infertile.
    626.X is used when it has been determined that the patient is in fact infertile and is being treated for such, if she has been given a drug that is only given for the treatment of infertility than you should use the 626 codes.
    Look at this link - it may help with more description!!

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