Previously, only few private and commercial insurance carriers were covering male infertility services. Fortunately, in recent time, more carriers have started covering the same. It would be important to check with insurance carrier and the patient’s carrier, if they do cover male infertility services, and obtain pre-authorization and pre-certification. In cases, where you're not sure if a carrier will cover to have the patient sign a waiver, an Advanced Beneficiary Notice, an ABN. It’s advisable to obtain information on coverage pre-visit if possible but often, this only occurs at the time of the visit.
Male infertility diagnoses which occur in the series 606
- We have the code 606.0, which is azoospermia. That means that zero sperm are seen in the patient’s ejaculate. This is absolute infertility. This infertility may be due to germinal aplaisia, no cell – no sperm cells are being made or spermatic – spermatogenic arrest where full arrest of sperm production, that is no mature sperm are produced. And sperm formation is halted and no cells appear in the ejaculate.
- We also have the code 606.1, which is oligospermia equivalent to a low sperm count. Infertility under these circumstances may be due to germ cell desquamation which is immature sperm appearing in the ejaculate; hyper – hypospematogenesis, low sperm production or incomplete spermatogenic arrest where there is partial arrest of halting or stopping of early sperm formation.
- Infertility may – code 606.8, infertility due to extratesticular causes. Infertility due to drug therapy, infection, obstruction of the efferent ducts of the system, previous radiation therapy or even systemic diseases as simple as the flu with fever and chills will lower sperm counts.
- We have the code 606.9 which is male infertility and this is an unspecified code. Here, we have scrotal varices. These are other male infertility ICD-9 diagnosis. Here, we have scrotal varices or a varicocele, 456.4. 600.3 is cyst of the prostate, secondary tube or actually causing ejaculatory duct obstruction.
- We have stricture of the vas, 608.85. 608.87 is retrograde ejaculation. And we have through ejaculatory duct obstruction, 608.89. We have a code V26.0 vasoplasty after previous sterilization. V26.21 fertility testing, sperm count for fertility testing. We have a code V26.22; this would be aftercare following sterilization reversal and would represent a sperm count after a vasovasotomy. You have the code V26.52, vasectomy status. This is a patient who has had a vasectomy and V25.8, other specific contraceptive management. And this would be a post – this would include a post-vasectomy sperm count or semen analysis.
- The 752.89 are other specific anomalies of the genital organs leading to male infertility such as absence of the prostate, congenital absence of the spermatic code and the vas. Complete occlusion or atresia of the ejaculatory ducts or vas deferens may also be a congenital abnormality. Lack of one testicle such as monorchism or a congenital small testicle also known as hypoplasia of the testis.
- And then we have the code V45.77 acquired absence of an organ, genital organs such as in a patient who has had an orchiectomy. And here, we have other diagnostic codes. These are encounters for contraceptive management. V25.04 is counselling and instruction in natural family planning to avoid pregnancy. V26.41 is procreation counselling and advice using natural family planning. And this would be regard to some hereditary problems that may be involved with the mother and father. V26.49 you have other procreative management, counselling and advice. Now V-codes, as we know, are used as secondary (diagnoses) – diagnoses providing information on the clinical circumstances as secondary diagnoses are not reimbursed by many carriers if used as primary diagnoses.
Now, we've spoken about some male infertility diagnoses. And after revealing these diagnoses, remember that many insurance carriers – but they're becoming less –are covering infertility but there are some carriers still out there that do not cover or reimburse for services billed with these male infertility diagnoses. Patients are then responsible for these services, financially responsible and should be made aware of this financial responsibility hopefully before you see the patient or certainly after services have been provided.