Brucellosis by Pat Conrad MD

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In anticipation of the Diane Sawyer, uh, sit down with former Olympian Bruce Jenner, the topic is sure to come up in your practice. As the transgender continues to multiply, further complicated by the impending ICD-10, here is the latest info to assist you in treating the LGBTWTFE community.

“ICD-9-CM 302.85 converts approximately to: 2015 ICD-10-CM F64.1 Gender identity disorder in adolescence and adulthood … or …. 2015 ICD-10-CM Z87.890 Personal history of sex reassignment.”
From Tufts Health Care:

“Gender reassignment surgery is part of a treatment plan for gender identity dysphoria (World Professional Association for Transgender Health [WPATH], 2014). When the (coverage) guidelines are met, Tufts Health Plan may authorize one or more of the following covered surgeries, up to the Member’s benefit limit:

Male-to-Female Procedures

– Penectomy
– Orchiectomy
– Vaginoplasty
– Clitoroplasty
– Labiaplasty
– Vulvoplasty
– Mammaplasty (breast augmentation)
– Prostatectomy
– Urethroplasty

Tufts Health Plan does not cover the reversal of any of the procedures listed above. Tufts Health Plan does not cover the surgical procedures listed below performed for the purpose of transgender surgery because they are considered cosmetic for all Members :

– Facial bone reduction
– Blepharoplasty
– Breast augmentation or reconstruction to alter breast contour
– Rhinoplasty
– Rhytidectomy
– Osteoplasty
– Genioplasty
– Forehead augmentation
– Penile prosthetic
– Reduction thyroid chondroplasty
– Body contouring procedures, i.e., abdominoplasty, suction-assisted lipoplasty, liposuction or lipofilling

According to the American Academy of Professional Coders:

“Claims for some transgender or hermaphrodite services may be inadvertently denied due to sex-related edits unless these services are billed properly. The National Uniform Billing Committee (NUBC) approved condition code 45 Ambiguous gender category to identify these unique claims and to allow proper processing.

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