EmailAdmission for IVF involving males
Publication Date: September 2005
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 2154
Scenario: Patient (male) admitted for PESA (Percutaneous Epididymal Sperm Aspiration) under GA as part of IVF procedure. The sperm obtained is sent to the IVF laboratory.
According to ACS1437, the appropriate diagnosis code would appear to be Z31.2 In vitro fertilisation. However, system edits (both at hospital level, Victorian DHS level and NCCH ASCII file level) prevent the entry of this diagnosis code for a male patient. ACS1437 is reproduced below, with emphasis added (underlined).
Infertility
When an admission for investigation or treatment of infertility (either male or female), a code from category N97 Female infertility or code N46 Male infertility should be assigned as principal diagnosis.
IVF
When an admission is specifically for IVF procedures, and the principal diagnosis is “IVF” or “infertility”, Z31.2 In vitro fertilisation should be assigned as the principal diagnosis code. An additional code from category N97 Female infertility, for the type of infertility may be assigned if known, including N97.4 Female infertility associated with male factors.
As PESA is a procedure carried out specifically for IVF, and the standard states “either male or female”, according to the standard when admission is specifically for PESA and IVF (or infertility) has been documented as the principal diagnosis, Z31.2 should be assigned.
The NCCH database contains the following query, number 1914, dated 15/03/2004:
Q. What code is used for Principal Diagnosis for males being admitted for IVF treatment?
A. Male admitted for aspiration of sperm for IVF under LA. (Female admitted at same time for TVOR). If Z31.2, In vitro fertilisation is used, it is ungroupable. Z31.2 appears the most appropriate code, but have only up to this stage tended to be assigned for the females only. A male infertility code is not appropriate as it is not treatment for the infertility, but IVF treatment. The NCCH suggests Z31.3 'Other assisted fertilisation methods' for the scenario cited.
In addition, Coding Matters Volume 11 Number 3 December 2004 states:
“Aspiration of sperm for IVF
The NCCH received a query regarding code assignment for male patients admitted for aspiration of sperm for IVF. Z31.3 Other assisted fertilisation methods should be assigned for these cases. Assign also an appropriate procedure code, as per documentation.”
We are following this advice from NCCH, but feel that Z31.2 is the correct code for males admitted for IVF procedures according to the Standard and current code indexing.
Would VICC consider suggesting to NCCH either
(a) That indexing for Admission for IVF be amended to direct male admissions to Z31.3 and female admissions to Z31.2 and that ACS1437 Infertility be amended to reflect that for IVF procedures, Z31.2 is appropriate for female patients and Z31.3 for male patients, in line with their advice in Coding Matters
or
(b) That the ASCII file be amended to enable Z31.2 to be used for both male and female patients where admission is for IVF (as ASC1437 Infertility currently directs).
According to ACS1437, the appropriate diagnosis code would appear to be Z31.2 In vitro fertilisation. However, system edits (both at hospital level, Victorian DHS level and NCCH ASCII file level) prevent the entry of this diagnosis code for a male patient. ACS1437 is reproduced below, with emphasis added (underlined).
Infertility
When an admission for investigation or treatment of infertility (either male or female), a code from category N97 Female infertility or code N46 Male infertility should be assigned as principal diagnosis.
IVF
When an admission is specifically for IVF procedures, and the principal diagnosis is “IVF” or “infertility”, Z31.2 In vitro fertilisation should be assigned as the principal diagnosis code. An additional code from category N97 Female infertility, for the type of infertility may be assigned if known, including N97.4 Female infertility associated with male factors.
As PESA is a procedure carried out specifically for IVF, and the standard states “either male or female”, according to the standard when admission is specifically for PESA and IVF (or infertility) has been documented as the principal diagnosis, Z31.2 should be assigned.
The NCCH database contains the following query, number 1914, dated 15/03/2004:
Q. What code is used for Principal Diagnosis for males being admitted for IVF treatment?
A. Male admitted for aspiration of sperm for IVF under LA. (Female admitted at same time for TVOR). If Z31.2, In vitro fertilisation is used, it is ungroupable. Z31.2 appears the most appropriate code, but have only up to this stage tended to be assigned for the females only. A male infertility code is not appropriate as it is not treatment for the infertility, but IVF treatment. The NCCH suggests Z31.3 'Other assisted fertilisation methods' for the scenario cited.
In addition, Coding Matters Volume 11 Number 3 December 2004 states:
“Aspiration of sperm for IVF
The NCCH received a query regarding code assignment for male patients admitted for aspiration of sperm for IVF. Z31.3 Other assisted fertilisation methods should be assigned for these cases. Assign also an appropriate procedure code, as per documentation.”
We are following this advice from NCCH, but feel that Z31.2 is the correct code for males admitted for IVF procedures according to the Standard and current code indexing.
Would VICC consider suggesting to NCCH either
(a) That indexing for Admission for IVF be amended to direct male admissions to Z31.3 and female admissions to Z31.2 and that ACS1437 Infertility be amended to reflect that for IVF procedures, Z31.2 is appropriate for female patients and Z31.3 for male patients, in line with their advice in Coding Matters
or
(b) That the ASCII file be amended to enable Z31.2 to be used for both male and female patients where admission is for IVF (as ASC1437 Infertility currently directs).
Response
The Victorian ICD Coding Committee recognises the issues highlighted by the enquirer and has referred the enquirer’s suggestions to the NCCH. In the meantime coders should follow the advice provided in Coding Matters Volume 11 Number 3 December 2004.
