Reimbursement Advisor

Estradiol assessment: What’s the difference?

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Q When we draw estradiol on our fertility patients, we use CPT code 82670 (assay of estradiol). The insurance company changed this to 80415 (chorionic gonadotropin stimulation panel; estradiol response panel), saying it “better represents the services performed.” Is that correct?

A Code 80415 includes a baseline level of estradiol, preferably pooled with 3 samples at 15- to 20-minute intervals. After the baseline is taken, 5,000 U of human chorionic gonadotropin (hCG) are administered intramuscularly. Then, 3 days later, a pooled sampling of estradiol is repeated for response to the evocative agent. This is done to detect ovarian production of estradiol in response to hCG.

If you are not giving hCG to test the response, then the insurer is incorrect and you are right to assign 82670.

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.

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