Correct coding for laboratory procedures during assisted ...

1 Correct coding for laboratoryprocedures during assistedreproductive technology cyclesCoding Committee of the American Society for Reproductive MedicineAmerican Society for Reproductive Medicine, Birmingham, AlabamaThis document provides updated coding information for services related to assisted repro-ductive technology procedures . This document replaces the 2012 ASRM document of thesame name. (Fertil Steril 2016;-:- -. 2016 by American Society for ReproductiveMedicine.)Discuss:You can discuss this article with its authors and with other ASRM members your smartphoneto scan this QR codeand connect to thediscussion forum forthis article now.** Download a free QR code scanner by searching for QRscanner in your smartphone s app store or app should code accurately forthe services they provide and the diag-noses that justify those services. Cur-rent Procedural Terminology (CPT)2016 is a listing of procedures per-formed by physicians and other healthcare professionals and is maintainedby the American Medical Association(AMA).

2 It is generally accepted as theuniversal reporting system for servicesperformed in the United States as wellas many other countries around theworld. Each procedure in CPT is re-ported with afive-digit code that maybe further explained by the additionof various two-digit PERSPECTIVEIn vitro fertilization (IVF) involves amultitude of complex laboratory proce-dures performed over an interval of 1 to7 days. These procedures involve boththe male and female gametes as wellas the subsequent embryos thatdevelop. Current Procedural Terminol-ogy initially had only one code todescribe the laboratory proceduresthat took place from the time the oocytewas aspirated from the ovary until theembryo was transferred to the uterusor was cryopreserved. A single codequickly became inadequate to describethe many different components ofwork involved as the variety andcomplexity of assisted reproductivetechnology (ART) expanded.

3 As tech-nology has changed, new CPT codeshave been added to describe the workperformed in the ART document outlines the properuse of individual and specific codesfor each component of the laboratorywork involved in an IVF of multiple procedures intoone or two codes is no longer appro-priate, because each of these codes de-scribes distinct and separatelyidentifiable work involved in the labo-ratory during an IVF laboratory part of the work inan IVF cycle may involve any or all ofseveral procedures currently definedby CPT. In general, proceduresinvolving the oocyte or embryo arecoded for the female partner, whereasthose directly involving sperm aloneare coded for the male partner. Alterna-tively, all of these procedures may beapplied to the following CPT codes (89250 89398, as well as CPT level III codes0058T and 0357T) may be applicablein the IVF cycle .

4 Codes are presentedin the order they are listed in the CPTbook, rather than the sequence in whichthey are typically performed in an ART CODES89250 Culture of Oocyte(s)/Embryo(s), Less than 4 DaysThis code describes only the culture ofoocyte(s)/embryo(s) for duration of cul-ture of less than 4 days. It includes theday of insemination but not the proce-dure involved with the insemination(conventional and/or assisted fertiliza-tion [89268, 89280, 89281]). It doesnot include oocyte identification fromfollicularfluid (89254) or preparationof embryo for transfer (any method)(89255). It does not include assistedembryo hatching, microtechniques(any method) (89253), cryopreserva-tion; embryo(s) (89258), or oocyte/em-bryo biopsy (89290, 89291). This codemay be reported whether culturingReceived December 16, 2015; accepted December 17, requests: coding Committee, American Society for Reproductive Medicine, 1209 MontgomeryHwy, Birmingham, Alabama 35216 and Sterility , ,-2016 0015-0282/$ 2016 American Society for Reproductive Medicine, Published by Elsevier COMMITTEE fresh oocyte(s)/embryo(s) or previously cryopreserved oo-cyte(s)/embryo(s).

5 89251 Culture of Oocyte(s)/Embryo(s), Less than4 Days; with Coculture of Oocyte(s)/Embryo(s)This code includes all of the work described by culture of oo-cyte(s)/embryo(s) (89250) with the additional work of cocul-turing the embryos with feeder cells (granulosa,endometrial, tubal, etc.). This code would also include thework involved in preparing the culture system. This code is re-ported instead of 89250 when coculture is utilized. It includesthe day of insemination but not the procedure involved withthe insemination (conventional and/or assisted fertilization[89268, 89280, 89281]). It does not include oocyte identifica-tion from follicularfluid (89254) or preparation of embryo fortransfer (any method) (89255). It does not include assisted em-bryo hatching, microtechniques (any method) (89253), cryo-preservation; embryo (89258), or oocyte/embryo biopsy(89290, 89291).

6 This code may be reported whether culturingfresh oocyte(s)/embryo(s) or previously cryopreserved oo-cyte(s)/embryo(s).89253 assisted Embryo Hatching, Microtechniques(Any Method)This code describes any micromanipulation technique used toassist hatching of the embryo from the zona pellucida. It in-cludes using acid Tyrode's solution, laser, or partial zonadissection (PZD) performed for this purpose. It is distinctfrom codes for culture of oocyte(s)/embryo(s) (89250), cultureof oocyte(s)embryo(s); with coculture of embryos (89251),extended culture (89272), and assisted oocyte fertilization;microtechnique (89280, 89281) and should be reported sepa-rately. This does not include preparation of embryo for trans-fer (any method) (89255).89254 Oocyte Identification from Follicular FluidThis code refers to the work of identifying the oocytes con-tained in the follicularfluid aspirated at the time of the oocyteretrieval.

7 This does not include any of the work involved infollicle puncture for oocyte retrieval, (any method) (58970)or the subsequent work of culture of oocyte(s)/embryo(s)(89250), the coculture of oocyte(s)/embryo(s) (89251), orextended culture (89272). This code is reported only onceper ART cycle regardless of the number of oocytes Preparation of Embryo for Transfer (AnyMethod)This code includes the following work: removing the em-bryo(s) from culture, preparing the embryo(s) for transfer,loading the embryo(s) into an appropriate catheter, transport-ing the embryo(s) to the transfer room for transfer to the pa-tient, and examination of the catheter after transfer to ensurethat no embryo(s) are retained. This code does not include thework of culture of oocyte(s)/embryo(s) (89250), or coculture ofoocyte(s)/embryo(s) (89251), extended culture (89272), and isnot a part of the work involved in embryo transfer, intrauter-ine (58974), or gamete, zygote, or embryo intrafallopiantransfer (any method) (58976).

8 It also does not include thaw-ing of cryopreserved embryo(s) (89352) or assisted embryohatching (89253). This code would be utilized for preparationof either a fresh or cryopreserved Sperm Identification from Aspiration (Otherthan Seminal Fluid)This code includes the work involved in identification ofsperm from an aspirate, usually from the vas deferens orepididymis. It specifically excludes identification of spermfrom seminalfluid; such work is described by other codes,including semen analysis; presence and/or motility of spermincluding Huhner test (postcoital) (89300), semen analysis;motility and count (not including Huhner test) (89310), semenanalysis; volume, count, motility, and differential (89320),semen analysis; sperm presence and motility of sperm, if per-formed (89321), or semen analysis; volume, count, motility,and differential using strict morphologic criteria ( , Kruger)(89322).

9 This code includes only the work of identifyingsperm and does not include the work of assisted oocyte fertil-ization, microtechnique (any method) (89280, 89281).89258 Cryopreservation; Embryo(s)This code includes the work of cryopreservation of the em-bryo(s), regardless of the stage of embryo development. Itdoes not include thawing of the embryo (89352) or subse-quent culture of oocyte(s)/embryo(s) (89250), or culture of oo-cyte(s)/embryo(s); with coculture of embryos (89251),extended culture (89272), or any subsequent charge for stor-age of the embryos (89342). It also does not include subse-quent preparation of embryo for transfer (89255).If embryos are cryopreserved on more than one day dur-ing the IVF cycle ( , pronuclear stage, cleavage stage, and/orblastocyst), it is appropriate to submit this code for each daythat additional work is Cryopreservation; SpermThis code includes the work involved in cryopreservation ofsperm.

10 It does not include: Semen analysis; presence and/or motility of spermincluding Huhner test (postcoital) (89300) Semen analysis; motility and count (89310) Semen analysis; volume, count, motility, and differential(89320), semen analysis; sperm presence and motility ofsperm, if performed (89321), or semen analysis; volume,count, motility, and differential using strict morphologiccriteria ( , Kruger) (89322) Sperm identification from aspiration (other than seminalfluid) (89257) Sperm identification from testis tissue, fresh or cryopre-served (89264) Sperm isolation; simple prep ( , sperm wash and swim-up) for insemination or diagnosis with semen analysis(89260) COMMITTEE Sperm isolation; complex prep ( , Percoll gradient, albu-min gradient) for insemination or diagnosis with semenanalysis (89261); or thawing of sperm or testicular tissue(89353, 89354).It also does not include any subsequent charge for storage(89342) or any equipment or supplies required for Cryopreservation; Reproductive Tissue,Ovarian0357T Cryopreservation; Reproductive Tissue,Immature Oocyte(s)These are both Category III codes.