Reimbursement Advisor

Infertility testing


Q Please clarify which codes we should use to bill for diagnostic testing (imaging tests and laboratory workups) for infertility. We currently use the code category 628.X; is the code V26.1 more appropriate?

A No, because it denotes a treatment for infertility (artificial insemination), not diagnostic testing. Further, the 628.X codes (infertility, female) should be used only when you have confirmed that the infertility is caused by the woman, not the male partner.

To appropriately bill for the diagnostic testing, use the code V26.21 (fertility testing) or V26.39 (other investigation and testing). While the former lists only fallopian tube insufflation and sperm count testing as specific examples, this code can be used to bill for any type of testing performed for infertility.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect 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.

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