icd code for checking testostrone level for transgendering

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.”

Is testosterone injection a modifier for transgender coding?

I use it a lot in transgender coding. It is not transgender exclusive, but a commonly know modifier for transgender coding. As for the testosterone injection, link it to the F64.1 code (Insurance companies deny the F64.9 code.

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 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 is diagnosis code F64 9?

Gender identity disorder, unspecifiedICD-10 code: F64. 9 Gender identity disorder, unspecified.

How do you code gender reassignment?

ICD-10-CM Diagnosis Codes 9 may be used to describe the type of gender dysphoria diagnosed. There is also a status code for personal history of sex reassignment (Z87. 890). Note that ICD-10 still uses the outdated terms of gender identity disorder and transsexualism.

What is the CPT code for phalloplasty?

The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary....CPT55899Unlisted procedure, male genital system [when specified as metoidioplasty or phalloplasty with penile prosthesis]56625Vulvectomy, simple; complete61 more rows

Who can give a 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 does condition code 45 mean?

Ambiguous Gender CategoryPolicy: For Part A claims processing, institutional providers shall report condition code 45 (Ambiguous Gender Category) on any outpatient claim related to transgender or hermaphrodite issues.

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.

What is procedure code 52356?

Code 52356 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [eg, Gibbons or double-J type]) includes the performance of lithotripsy and the insertion of the indwelling stent on the same side.

What is procedure code 17380?

CodeDescription15876 - 15879SUCTION ASSISTED LIPECTOMY; HEAD AND NECK - SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY17340CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE17360CHEMICAL EXFOLIATION FOR ACNE (EG, ACNE PASTE, ACID)17380ELECTROLYSIS EPILATION, EACH 30 MINUTES8 more rows

What is procedure code 19303?

To summarize, report code 19303 for a skin-sparing or nipple-sparing mastectomy for diagnosed carcinoma or for patients who are at high risk for carcinoma, regardless of the amount of skin removed or whether the nipple is preserved.

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.”

Should gender dysphoria be in the DSM 5?

The DSM–5 articulates explicitly that “gender non-conformity is not in itself a mental disorder.” The 5th edition also includes a separate “gender dysphoria in children” diagnosis and for the first time allows the diagnosis to be given to individuals with disorders of sex development (DSD).

Can gender dysphoria be caused by trauma?

Gender dysphoria currently exists as a mental health diagnosis, perpetuating stigma as well as pathologizing gender variance. Clinical social workers have preserved a harmful formulation that gender dysphoria is a disorder caused by trauma.

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:

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 ...

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.

Why is it important to record gender?

This information is important because it tells a doctor to offer preventive screening appropriate to the patient’s anatomy.

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.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862 (a) (1) (A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” Title XVIII of the Social Security Act, §1833 (e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. 42 Code of Federal Regulations (CFR) §410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions. CMS Internet Online Manual Pub.

Article Guidance

The following coding and billing guidance is to be used with its associated Local coverage determination.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

What are the codes for gender dysphoria?

Although there is no specific procedure code for people diagnosed with gender dysphoria who are choosing to transition, there are two CPT® codes that pertain to intersex surgery:#N#55970 Intersex surgery; male to female#N#55980 Intersex surgery; female to male#N#Codes 55970 and 55980 apply to surgery for newborns with ambiguous genitalia, as well.#N#Although not a comprehensive list, here are common procedures performed during gender transition surgery:#N#Vaginectomy (FTM) – Look to codes such as 58275 Vaginal hysterectomy, with total or partial vaginectomy, 57111 Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy), etc.#N#Urethroplasty (MTF and FTM) – Look to applicable CPT® codes 53410 – 53430.#N#Phalloplasty (FTM) – 55899 Unlisted surgery of the male genital system, for metoidioplasty and phalloplasty#N#Scrotoplasty (MTF) – 55175 Scrotoplasty; simple and 55180 Scrotoplasty; complicated#N#Penectomy (MTF) – 54125 Amputation of penis; complete#N#Vaginoplasty (MTF) – 57335 Vaginoplasty for intersex state#N#Labiaplasty (MTF) – 56625 Vulvectomy simple; complete#N#Clitoroplasty (MTF) – 56805 Clitoroplasty for intersex state#N#There are also surgical procedures associated with intersex surgery that payers typically consider to be cosmetic:#N#Abdominoplasty – 15830 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy#N#Blepharoplasty – 15822 Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)#N#Otoplasty – 69300 Otoplasty, protruding ear, with or without size reduction#N#Rhinoplasty – 30410 Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip#N#Genioplasty – 21120 Genioplasty; augmentation (autograft, allograft, prosthetic material)#N#Rhytidectomy – 15828 Rhytidectomy; cheek, chin, and neck

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.

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 gender identity centers established?

1960-1970 – Gender identity centers were established at Johns Hopkins, Stanford University, and the University of Minnesota, which legitimized the care and diagnosis of transgender individuals. 1973 – Burou had performed over 3,000 MTF operations by 1973.

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

Is low T a diagnosis?

If that patient is here for a testosterone injection, and you were to use a diagnosis of "low T" or something of that nature, it is incorrect because the patient is still technically a female and could not possibly have "low T" - physiologically OR technical ly.

Is testosterone transgender exclusive?

It is not transgender exclusive, but a commonly know modifier for transgender coding. As for the testosterone injection, link it to the F64.1 code (Insurance companies deny the F64.9 code. Also the code may change to F64.0 with October 1, 2016-17 new guidelines).