icd-10-cm code for transgender surgery

In addition, all facility claims reported with condition codes 45 and all professional claims reported with ICD-10 CM diagnosis codes F64.0; transsexualism, F64.1; gender dysphoria, F64.8; other gender identity disorders, F64.9 gender identity disorder, unspecified, Z87.890; personal history of sex reassignment and/or reporting modifier KX will exclude the claim from gender-conforming editing.

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What is the ICD 10 code for gender reassignment surgery?

And for revised code F64.1, ICD-10 instructs you to “Use additional code to identify sex reassignment status (Z87.890).” Question: “ Should I identify a patient as transgender if it doesn’t pertain to the services being rendered?”

What are the ICD-10 codes for Transgender Health Services?

When in doubt, consult the payer. BlueCross BlueShield (BCBS) of Nebraska advises, “When applicable, include the appropriate transgender ICD-10 codes (F64.x) as secondary information on claims for all services, including mental health and primary care services.”

What is the ICD 10 code for gender identity disorder?

Gender identity disorder, unspecified. F64.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM F64.9 became effective on October 1, 2018.

What are the criteria for gender reassignment surgery for Transmen?

The individual has knowledge of all practical aspects (e.g., required lengths of hospitalizations, likely complications, and post-surgical rehabilitation) of the gender reassignment surgery. When all of the above criteria are met for gender reassignment surgery, the following genital/breast surgeries may be considered for transmen (female to male):

Is there an ICD-10 code for transgender?

ICD-10 notes that new code F64. 0 covers both “Gender identity disorder in adolescence and adulthood” and “Gender dysphoria in adolescents and adults.” And for revised code F64. 1, ICD-10 instructs you to “Use additional code to identify sex reassignment status (Z87. 890).”

What is diagnosis code F64 9?

9: Gender identity disorder, unspecified.

What is diagnosis code Z98 890?

ICD-10 code Z98. 890 for Other specified postprocedural states is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What CPT code reports female to male surgery?

When reporting CPT® code 55980 (Intersex surgery; female to male), the following staged procedures to form a penis and scrotum using pedicle flap grafts and free skin grafts are included: Portions of the clitoris are used, as well as the adjacent skin.

What is ICD-10 code for gender dysphoria?

Please note that per ICD-10-CM inclusive notes for F64. 0, code F64. 0 covers both “gender identity disorder in adolescence and adulthood” and “gender dysphoria in adolescents and adults.”

How is gender dysphoria diagnosis?

Your health care provider might make a diagnosis of gender dysphoria based on: Behavioral health evaluation. Your provider will evaluate you to confirm the presence of gender dysphoria and document how prejudice and discrimination due to your gender identity (minority stress factors) impact your mental health.

What is G89 29 diagnosis?

ICD-10 code G89. 29 for Other chronic pain is a medical classification as listed by WHO under the range - Diseases of the nervous system .

Is Z98 890 billable?

Z98. 890 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z98. 890 became effective on October 1, 2021.

What is the ICD-10 code for status post laparotomy?

ICD-10-CM Code for Encounter for surgical aftercare following surgery on the digestive system Z48. 815.

What is procedure code 55970?

CPT® 55970, Under Intersex Surgery The Current Procedural Terminology (CPT®) code 55970 as maintained by American Medical Association, is a medical procedural code under the range - Intersex Surgery.

Is gender reassignment surgery covered by insurance?

Many health plans are still using exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for certain health care services.

What is procedure code 19318?

It recommends CPT code 19318 for reduction mammaplasty when breast tissue is removed for breast-size reduction and not for treatment or prevention of breast cancer.

What are the signs of gender dysphoria?

You may feel: certain that your gender identity conflicts with your biological sex. comfortable only when in the gender role of your preferred gender identity (may include non-binary) a strong desire to hide or be rid of physical signs of your biological sex, such as breasts or facial hair.

What does unspecified PTSD mean?

Code F43. 10 is the diagnosis code used for Post-Traumatic Stress Disorder, Unspecified. It is an anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress, such as military combat, violent assault, natural disaster, or other life-threatening events.

What does anxiety F41 9 mean?

Code F41. 9 is the diagnosis code used for Anxiety Disorder, Unspecified. It is a category of psychiatric disorders which are characterized by anxious feelings or fear often accompanied by physical symptoms associated with anxiety.

What is transgender medical?

Transgender is a broad term used for people whose gender identity or gender expression differs from their assigned sex at birth. Proper diagnosis and procedural coding of transgender medical services begins with understanding the spectrum of gender identity variations.

When did transgender surgery start?

Although gender dysphoria has been around throughout history, transgender surgery only began in the early 1900s. Here is a time line of its progress in the medical field: 1930 – Under the care of Magnus Hirschfeld, Lili Elbe became the first person to undergo transsexual surgery.

How does gender dysphoria manifest?

Gender dysphoria is manifested in a variety of ways, including a strong desire to be treated as the other gender or to be rid of sex characteristics, or a strong conviction that the patient has feelings and reactions typical of the other gender.

How long does gender dysphoria last?

For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign to him or her, and it must continue for at least six months. In children, the desire to be of the other gender must be verbalized.

What is the difference between gender identity and intersex identity?

Gender identity — A person’s innate identification as a man, woman, or something else that may (or may not) correspond to the person’s external body or assigned sex at birth. Intersex — Individuals with a set of congenital variations of the reproductive system that are not considered typical for either male or female.

When were transgender standards first published?

1979 – The first standards of care for transsexuals were published by the Harry Benjamin International Gender Dysphoria Association, now known as the World Professional Association of Transgender Health.

When was transsexualism included in the DSM?

1980 – Transsexualism was included in the third edition of the DSM (DSM-III).

What is the ICd 9 code for transsexual?

Covered diagnoses in ICD-9-CM include: 302.50 – Trans-sexualism with unspecified sexual history. 302.51 – Trans-sexualism with asexual history.

What is the code for intersex surgery?

Many of the policies do not accept the codes 55970 Intersex surgery; male to female or 55980 Intersex surgery; female to male. Rather, they require that the claim be filed with the CPT code that represents the specific procedure. For example, for male-to-female surgery the following may be coded: Orchiectomy (54520, 54690) Penectomy (54125)

How old do you have to be to get a gd?

The individual must be at least 18 years of age; The individual must be diagnosed with GID or GD; The individual must have successfully lived and worked with the desired gender role full-time for at least 12 months to two years (depending on policy/insurance) without returning to the original gender; Gender reassignment surgery must be ...

Does insurance cover gender reassignment?

The following are commonly covered diagnoses for gender reassignment; however, it is important to research your patient’s insurance coverage to determine coverage, as specific coverage for individual and group policies can vary within an insurance company. Just because two patients are covered by the same insurance company does not necessarily mean their policies cover the same services.

Does Medicare cover gender reassignment surgery?

Most major insurance, including Medicare, cover gender reassignment surgery under very specific guidelines. Though there are many similarities in the medical policies for gender reassignment surgery among the various major insurance companies, if the provider you work for is providing this service, you will need to find ...

What is the ICd 10 code for transsexualism?

You might consider using diagnosis code F64.0, Transsexualism, in addition to an appropriately leveled Evaluation and Management (E/M) code. Please note that per ICD-10-CM inclusive notes for F64.0, code F64.0 covers both “gender identity disorder in adolescence and adulthood” and “gender dysphoria in adolescents and adults.”

What is condition code 45?

Per the CMS Transmittal, condition code 45, Ambiguous Gender Category, needs to be reported on Part A Medicare claims to identify transgender- or hermaphrodite-related cases. The presence of this condition code on your claim will allow sex-related edits to be bypassed so your claim can be processed like other regular Medicare claims.

What is gender incongruence?

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least two of the following:

How long does it take to become a gender?

That the patient has completed twelve months of continuous, full-time, real-life experience (i.e., the act of fully adopting a new or evolving gender role or gender presentation in everyday life) in the desired gender.

What happens if you don't list procedure codes?

All unlisted procedure codes will suspend for medical review.

Is a gender specific screening necessary?

Gender specific screenings may be medically necessary for transgender persons appropriate to their anatomy. Examples include:

Is gender reassignment surgery risky?

Gender reassignment surgical procedures are not without risk for complications; therefore, individuals should undergo an extensive evaluation to explore psychological, family, and social issues prior to and post surgery.

Is prostate cancer screening necessary for transwomen?

Prostate cancer screening may be medically necessary for transwomen who have retained their prostate.

What is gender dysphoria?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) refers to this as “gender dysphoria.”. “It is important to note,” DSM-5 states, “that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with ...

What is the Joint Commission's recommendation for gender identity data?

The Joint Commission and others have recommended that gender identity data be routinely collected in healthcare settings. “From a clinical standpoint,” the authors of the transgender healthcare guide write, “collecting this data is essential to providing high-quality care to transgender patients.”#N#They also recommend hospitals adopt admitting/registration procedures that enable transgender patients to designate their gender identity and name in use, even when this identity differs from how their medical insurance or legal documents identify them.#N#The authors of the guide propose the follow-ing admitting/registration procedures:

How long does gender dysphoria last?

According to DMS-5, “For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months.

Can a transgender man have a uterus?

For example, a transgender man may still have a uterus and require gynecological exams. Providers are generally able to reverse gender-related denials, but not without both the provider and patient being inconvenienced. The Centers for Medicare & Medicaid Services (CMS) already thought of this.

Does Medicare cover hormone therapy?

Medicare covers medically necessary hormone therapy and sex reassignment, as well as routine preventive care, regardless of gender markers. CMS advises institutional providers to use claim level condition code 45 Ambiguous gender category to identify such claims that pose a gender/procedure conflict.

Is transgender status protected under HIPAA?

A patient’s transgender status or history of transition-related procedures may constitute protected health information under the HIPAA Privacy Rule. Providers should develop, implement, and train staff on the organization’s privacy policy regarding this matter. Resources.