Endometriosis
A summary of common codes for Endometriosis compiled by the ASRM Coding Committee. Endometriosis is a particularly difficult field for coding owing to extensive variability in symptoms, severity, and location. Severe disease can result in subspecialty support from gynecologic oncology, urology, general or colorectal surgery, and even cardiothoracic surgery in the case of diaphragmatic endometriosis. Though there are exceptional reproductive surgeons capable of procedures normally reserved for other fields, this summary will focus on conditions and procedures that can be performed by the majority of REI’s and OB/GYN’s.
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Coding Q&A
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Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee.
Mental-health Services During Assisted Reproduction
A summary of codes for Mental-health Services During Assisted Reproduction compiled by the ASRM Coding Committee.
Recurrent Pregnancy Loss (RPL)
Strategy for coding for a patient with RPL - codes compiled by the ASRM Coding Committee.Coding Corner
Coding Corner is segmented into the following sections. Click an image below to view questions and answers in that section.
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Topic Resources
View more on the topic of endometriosis
Fertility and Sterility On Air - Unplugged: October 2024
Topics include: mechanical contractions and fibroid progression, endometriosis classification and risk of infertility, fertility coverage for military personnel and more. Listen to the Episode
Billing for E/M Visits
When billing Evaluation & Management (E/M) visits based on medical decision-making, would we View the Answer
How to Spot Endometriosis in 10 Minutes!
Learn how to identify endometriosis in patients within 10 minutes by gathering thorough menstrual history, spotting GI symptoms, and building a support team. View the ASRMed Talk Video
Journal Club Global: Actualidad En Tratamientos De Fertilidad Para Pacientes Con Endometriosis
Live in Spanish from the 2024 Peruvian Fertility Society Meeting - Lima, Peru View the Video
Exclusion of IVF services due to Z31.83
My wife and I have been seeking IVF treatment and this year coverage was added to my benefits for infertility treatment (up to $25,000). View the Answer
Coding for aspiration of hydrosalpinx and endometrioma
Surgery was performed under anesthesia for Aspiration of right hydrosalpinx fluid and right endometrioma. Which CPT code would be best to use? View the Answer
IVF coverage denied for Z31.83 diagnosis code
My wife and I have been seeking IVF treatment and coverage was added for infertility treatment (up to $25,000) but our insurer keeps denying it. View the Answer
Endometriosis and infertility: a committee opinion (2012)
Women with endometriosis typically present with pelvic pain, infertility, or an adnexal mass, and may require surgery. View the Committee Opinion
Medication Administration
Is CPT code 96402 applicable to a Depo-Lupron or Zoladex injection by nurse at REI practice, even if there is no diagnosis of cancer? View the Answer
Endometriosis and Infertility
For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
Excision Ovarian Endometrioma
What code is used for a laparoscopic excision of endometriosis and an ovarian excision of endometrioma with bilateral ureterolysis is performed. View the Answer
Drs. Camran, Farr, and Ceana Nezhat Travel Scholar Award for Endometriosis
The objective of this award is to provide any trainee whose abstract submission focuses on endometriosis to expand their experience in the field. View the Award Information
Journal Club Global: Surgical management of endometriosis in women diagnosed with infertility (Spanish language)
Fertility and Sterility is excited to partner with our global professional colleagues to begin broadcasting regular Journal Club Global events in Spanish.
View the Video
Journal Club Global: Non-invasive Diagnosis of Endometriosis
One of the most exciting developments in the field of endometriosis is the push towards earlier and less invasive approaches to diagnosis. View the Video
Journal Club Global - Does the Endometrium Play a Major Role in Endometriosis-Associated Infertility
This will be a virtual event in the style of the "Fertile Battle" debate that took place at the 2019 SREI Fellows Symposium View the Video
Feb 2023: New Endometriosis and Isthmocele Codes
On June 9, 2022 the CDC issued updates to the ICD-10-CM code set reflecting more than 1,400 changes to your diagnosis coding options. View the Letter
Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
Endometriosis Special Interest Group (EndoSIG)
The mission of the Endometriosis Special Interest Group (EndoSIG) is to further the goals of the ASRM by fostering increased interest in the biology, pathophysiology and clinical management of endometriosis. Learn more about the EndoSIGTopic Resources
View more on the topic of insurance
Billing for Ultrasounds and Labs
When billing for ultrasounds and labs, is it necessary View the Answer
Use of Code 99211 for a Monitoring Appointment
Is it appropriate to use code 99211 if a patient is scheduled for a monitoring visit View the Answer
HyCoSy Bundled Code 0568T
When billing for HyCoSy, should the new code 0568T View the Answer
Fertility and Sterility On Air - Live from ASRM 2024: Part 2
Dive into the latest discussions on male fertility testing, U.S. insurance mandates for fertility treatments, and advancements in frozen embryo transfer research. Listen to the Episode
Appropriate Use of Modifier -25
Is Modifier -25 appropriate in the monitoring cycle when an ultrasound View the Answer
Billing for E/M Visits
When billing Evaluation & Management (E/M) visits based on medical decision-making, would we View the Answer
ASRM on Increased Availability of Fertility Coverage for Federal Employees
We are pleased with the news shared by OPM today showing more carriers will be providing infertility benefits to federal employees in the coming year.
View the Press Release
Nation’s Leading Professional Group for Fertility Care Professionals Calls for Passage of Right to IVF Act
ASRM applauds Majority Leader Schumer’s decision to seek reconsideration of the Right to IVF Act.
View the Press Release
Billing Physician vs Service Physician
What physician’s name must be on the treatment notes and who we are permitted to bill to insurance for: View the Answer
Mandated states and egg retrieval
What name should you use to submit for reimbursement for the actual egg donor when there is benefit for the donor egg retrieval? View the Answer
Billing 58558 together with 58560
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
IVF coverage denied for Z31.83 diagnosis code
My wife and I have been seeking IVF treatment and coverage was added for infertility treatment (up to $25,000) but our insurer keeps denying it. View the Answer
Cycle coordination fees and 99499, S4042
I reviewed cycle coordination fees, but see that there is no specific code for cycle management. View the Answer
Reimbursement for cost of donor egg
My wife and I are going through a fertility treatment process, and we have purchased a donor egg out-of-pocket from a donor bank. View the Answer
Coding for Ovarian tissue cryopreservation, experimental or not?
For Cryopreservation; Reproductive Tissue Ovarian- 0058T code is not being recognized. Is there an updated one being used or a replacement of this code? View the Answer
Supervising provider for embryology billing
We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
Billing 58558 and 58560 together
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
Endometrioma
Surgery was performed under anesthesia for Aspiration of right hyrosalpinx fluid and right endometrioma. View the Answer
Total versus Free estradiol
Should patients with fertility issues be billing Estradiol Free (82681) instead of Estradiol Total (82670)? View the Answer
Unlisted Fertility Treatment CPT Code
Can you please refer me to an unlisted management CPT code for fertility treatment? View the Answer
Vitamin D Testing in Infertility Patients
We are being told that, as of this year, vitamin D level screening is not being covered by many insurers. View the Answer
Z Codes Vs. Procedure Codes For Fertility Preservation Counseling
I am trying to understand better when to use the procreative management code vs the fertility preservation counseling and procedure codes. View the Answer
ICD-10 Code For Intrauterine Insemination (IUI) For Same-Sex Couple
Which ICD-10 code you recommend for IUI same gender couples? View the Answer
Initial Visit for Infertility With No Mandated Coverage
What code would be appropriate for an initial visit for infertility? View the Answer
Non-REI Board Certified MD Performing REI Procedures
My boss has a few follow up questions about a non-REI board certified MD performing REI procedures. View the Answer
Embryo Culture Denied As Experimental
We have received denials from insurance payers when billing CPT code 89251. View the Answer
Flat Fee For Outside Monitoring
Can our office charge outside monitoring patients a flat fee to be seen? View the Answer
Frozen Embryo Transport
What is the code for the cost of frozen embryo transport? View the Answer
Global Billing Vs Billing Under Provider
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
Diagnosis Codes For Intrauterine Insemination (IUI)
I was reviewing your Coding Corner information to find a definitive diagnosis for IUI procedures. Which diagnosis is the most appropriate? View the Answer
Donor Egg-Retrieval On Recipient's Claim
Is the donor egg retrieval included on the bill to insurance with the first IVF treatment for the recipient? View the Answer
Billing at an Outside Clinic for Lab Services
One of my physicians uses an outside facility to perform the retrievals and transfers. View the Answer
Billing For Cryopreservation Of Embryos Under The Male Partner
Can 89258 be billed under the male partner of a female patient? View the Answer
Billing For Procedures Performed By Outside Physicians
Our physician tested positive for COVID-19, so another physician not associated with our office performed our egg retrievals and embryo transfers. View the Answer
Board Certified Vs. Non-Board Certified Billing
Is coding/billing any different when a non-board certified or non-REI provider submits for REI procedure? View the Answer
Claim Form for Donor Egg Retrieval
What bill form is used of IVF donor egg retrieval? View the Answer
Coding For Alpha-Fetoprotein Testing
My clinic is looking into implementing Alpha-Fetoprotein (AFP) testing. I understand there is currently no CPT code listed for this testing. View the Answer
Coding For Donor Egg Retrieval For Male Intended Parent
In coding a donor-egg retrieval to bill to insurance under the male intended parent, would it be appropriate to use the Z31.83? View the Answer
Coding For Long-Term Storage Of Embryos
We have recently been contacted by a payer stating we have a patient whose plan will cover long-term storage of her embryos. View the Answer
Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
Mental-health Services During Assisted Reproduction
A summary of codes for Mental-health Services During Assisted Reproduction compiled by the ASRM Coding Committee. View the Coding Summary
PCOS
A summary of codes for PCOS as compiled by the ASRM Coding Committee. View the Coding Summary
Recurrent Pregnancy Loss (RPL)
Strategy for coding for a patient with RPL - codes compiled by the ASRM Coding Committee. View the Coding Summary
Laboratory Procedures during ART Cycles
A listing of codes, compiled for a fresh ART cycle, transfer, biopsy, cryopreservation of embryos and oocytes, storage, and thawing. View the Coding Summary
Embryo Transfer
A summary of Embryo Transfer codes collected by the ASRM Coding Committee View the Coding Summary
Fibroids
A summary of codes to use with fibroids and myomas compiled by the ASRM Coding Committee View the Coding Summary
Fertility Preservation
A summary of codes for Fertility Preservation compiled by the ASRM Coding Committee. View the Coding Summary
Jan 2022: Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services. View the Letter
Feb 2021: CMS holds physicians harmless from Merit-based Incentive Payment System (MIPS) penalties amid COVID-19 Public Health Emergency
CMS announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency. View the Letter
Jan 2021: Coding for COVID-19 Vaccine Administration
AMA has published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations. View the Letter
Jan 2021: Telehealth Coding Extension and 2021 Medicare Physician Fee Schedule
Effective January 11, 2021, the U.S. Department of Health and Human Services' Secretary Azar has extended the COVID-19 Public Health Emergency (PHE). View the Letter
