Need insurance code help - please!!!

[Janine3112]

Hello Girls!

I hope somebody can help me! I'm one of the lucky ones that has an Insurance that (at least claims to ) cover some of my cost. My problem is, that my Doctors Office is private and they do not deal with Insurances at all. So I have to pay everything and then send in a claim. But my Insurance requires me to put a Treatment Code on my Claim. My Doctors Office does not work with Codes, since they don't work with Insurances. And I tried to google but really can not find anything... Maybe any of you are lucky enough to have an Insurance and maybe you can look at your paperwork and tell me what kind of codes the Doctors use? That would just be soooo awesome! They will not reimburse me anything if I don't provide all information.... I just have no idea how to find out....

I need Treatment Codes for:
FET
IVF
ICSI

And Diagnosis Codes for:
male factor infertility

you would really help me sooo much!!!
Thanks for every reply!!!

[SC-Stargazerlily]

This site has male factor listed: Employers - Infertility Related Diagnosis Codes - ARC

On this site, a good way down the page under Full Fees v. Cash discounts, it says that ins. companies do not accept a code for IVF. You have to submit for every single procedure. So, one for each u/s, each lab drawn, one for the ER procedure (probably laproscopy on the list above) and such. So, now that I see that, you can probably get most of the codes off of the link above. You are going to need to know exactly what labs they are drawing when they do blood work, E2, progesterone, FSH that kind of thing, and find the code for that. Here is the site I found this info: Cost of IVF at Advanced Fertility Center of Chicago Illinois

Hopefully, this helps.

ETA - I also found this site. It looks like you have to join, but I still thought I would post it. http://www.asrm.org/coding/

[Janine3112]

oh wow! the diagnosis codes are awesome!
But for the treatment codes,,,, i need Embryo Transfer... all the labs and medications is fine, i have that. just need the actual procedure of embryo culturing, transfer and freezing and thawing. that is what i can't find... but THANK YOU MUCH for that link!

[SC-Stargazerlily]

Okay, I found something else. It is a PDF and I'm not sure how to link that. Here is a link the google search I found it in. It is the 3rd one down, "[pdf] correct coding for laboratory procedures..."

Google

[SC-Stargazerlily]

The 6th one down on that list, also a pdf, is good too, but it's older. Some of the codes could be outdated. But, it is in a chart for and has ER and ET listed. ET would be the same for IVF or FET. You just wouldn't have the ER for the FET. It also has ICSI listed.

ETA - They are both from 2008. You could call your insurance company and give them code and ask what it's for to make sure it's correct.

[Janine3112]

this is awesome! you helped me sooo much. so just in case anybody has this same problem again, here is what i found:
the five diget numbers are the billing codes.

Transvaginal Oocyte Retrieval 58970
Ultrasound Guidance for Oocyte Retrieval 76948
Complete Semen Analysis 89320
Complex Sperm Prep for IVF 89261
Oocyte Identification 89254
Insemination of Oocytes 89268
Culture of Oocyte/Embryos < 4 days 89250
Preparation of Embryos for Transfer 89255
Practice Transfer Catheter 99070
Embryo Transfer 58974
Ultrasound Guidance for Embryo Transfer 76942
Intracytoplasmic Sperm Injection, ≤ 10 eggs 89280
Intracytoplasmic Sperm Injection, > 10 eggs 89281
Assisted Embryo Hatching 89253
Extended Embryo Culture 89272
Embryo Cryopreservation (includes one year storage) 89258
Annual Embryo Storage Fee (per year) 89342
Thaw/Prepare Frozen Embryos for Transfer 89352
Sperm Cryopreservation 89259
Thawing of Cryopreserved Sperm/Semen 89352
Annual Sperm Storage Fee (per year) 89343

[milo]

Not to rain on your parade, but medical billing is extremely complicated (I am in the medical field) and I doubt you are going to get any help from your insurance company in sorting it out. It can go way beyond just simple diagnosis codes, and I worry that you may still be left with significant bills. For example, your insurance company may have a set amount that it is willing to reimburse for each code, and if your doctor charges more than that, you will be out of luck.

Can you ask to speak to someone from your doctor's office that has gone through the same experience and can offer advice? Is it absolutely necessary that you use this particular office, vs. one that will be covered by your insurance?

Best of luck to you.

[SC-Stargazerlily]

Not to rain on your parade, but medical billing is extremely complicated (I am in the medical field) and I doubt you are going to get any help from your insurance company in sorting it out. It can go way beyond just simple diagnosis codes, and I worry that you may still be left with significant bills. For example, your insurance company may have a set amount that it is willing to reimburse for each code, and if your doctor charges more than that, you will be out of luck.

Can you ask to speak to someone from your doctor's office that has gone through the same experience and can offer advice? Is it absolutely necessary that you use this particular office, vs. one that will be covered by your insurance?

Best of luck to you.

This is a very good point. I had forgotten about the amounts. I've filed claims myself before and had it paid, but it's been for much less complicated things. I hope you can make it work.

[Janine3112]

I have already done the treatments, and yes, unfortunately this is the only office in the region. so I have already paid anyways. now it's just about trying to get something back. Unfortunately nobody is willing to help at all. The Dr. Office does not know and does not care since they do have their money already. Even the Insurance said they could not give me codes... it's stupid! So I will just try my best and see what if any i can get back. If not, so be it. There is absolutely nothing I can do anyways... unfortunately....

[SC-Stargazerlily]

Well, it never hurts to try. I did file myself for something once and was able to get reimbursed. I think you should be able to get something at least. Anything is definitely better than nothing, so it's definitely worth a try.