Postcoital exam denied: Now what?

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.