Transgender Care

I have a question about a patient who is a transgender male to female. The patient has had sexual reassignment surgery; however, she comes in for medroxyprogesterone acetate (Provera) and spironolactone medication refills as well as injections of estradiol valerate (Delestrogen). We initially had coded it as Z87.890 and, of course, insurance denied it. The patient disputed the denial because she states that she is legally a female now. An addendum was added stating that the patient suffers from intersexuality, endocrine disorder. At that time, per my coding manager, we changed the coding to F64.0. We are questioning if this is the correct way of the order of diagnoses or if you have any other thoughts on how this should be coded.


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