Cracking the Code
When coding medical cases pertaining to transgender individuals, there is certain criteria that a provider must meet within their documentation for the patient to have the medical procedure fully covered by their insurance. There must be a final diagnosis in the provider’s documentation for gender dysphoria. The formal diagnosis is gender identity disorder (GID), which is when a person experiences significant gender dysphoria. If this information is missing, then it is highly likely that the encounter will result in a denial. Please be sure to read the provider’s documentation fully to ensure all important information is captured when reporting final diagnoses and procedures for that encounter.