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Posted By Damaris S on 04-28-2018, 20:29:42 in Ob-Gyn
Dear Melanie,

We see patients regarding Fertility, so before we see the patients for their initial visit the infertility benefits are checked with the insurance carrier. Many Infertility patients have underlying medical problems, therefore, they need to be evaluated and tested before the actual infertility diagnosis is made. We have used the Z31.89 diagnosis (Procreative) together with the other medical problems the patient has to bill for their evaluation and management visits. However, just recently BC/BS is denying claims for those patients that have just the basic coverage (testing and evaluation) in their policy. Would you please clarify if a procreative diagnosis is considered infertility, because BC/BS is the only insurance carrier doing this right now.

Thanking you in advance for your reply,
Comments (1)
Posted By Melanie Witt on 04-29-2018, 14:17:02
I wonder if you should not be using Z31.49, Encounter for other procreative investigation and testing, instead. Procreative codes are used when the patient is trying to get pregnant, but does not necessarily imply the patient is infertile.
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