Medical Billing & Coding for a Transgender Patient

Doctor helping peopleThere has been a lot of recent talk in the news about the rights of transgender people and this should be of special interest to anyone working in the healthcare field. Medical billers & coders routinely have to code for procedures that specify male or female. How does one code if the patient is genetically a male but identifies as a female or vice-versa? Won’t coding for a gender that is opposite of the patient’s biological sex disrupt the health insurance process?

Clinics are being encouraged to develop a system that neutralizes incidences of discrimination and protects transgender patients from being “exposed.” Some insurance companies are now allowing coverage for gender reassignment surgery for patient’s that meet the criteria of gender dysmorphic disorder. Following the surgery, there are additional medical complications that could arise and further confuse the coding system that does not allow for a biological female having penile issues, etc. It is becoming apparent that are medical billing & coding system training is going to need to change to align with a society that believes an individual ought to be able to choose his or her own sex.

There are some coding systems that are in development now that will allow medical billers & coders to actually change the sex of the individual depending on the procedure. This means that a person who visits the office for a routine procedure like a test for strep throat will be able to identify as their chosen gender, whereas with more biologically dependent procedures such as a mammogram “she” would be coded as a female. Some clinicians and medical billers and coders are concerned that such lax rules governing the medical coding system could cause confusion amongst healthcare providers. As it stands now, most insurance companies still require certain codes to specify sex but this is likely to change in the future.

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