ICD-10 Coding for Transgender(F64.0, Z79.890, Z87.890)
Complete ICD-10-CM coding and documentation guide for Transgender. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Transgender
F64Primary Range
Gender identity disorders
This range includes codes for gender dysphoria and related conditions.
Hormone therapy for gender transition
Used for documenting ongoing hormone replacement therapy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| F64.0 | Transsexualism | Use when the primary reason for the visit is related to gender dysphoria management. |
|
| Z79.890 | Hormone therapy for gender transition | Use when documenting ongoing hormone therapy as part of gender transition. |
|
| Z87.890 | Personal history of sex reassignment | Use to document a patient's history of gender-affirming surgeries. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for transgender
Essential facts and insights about Transgender
Primary ICD-10-CM Codes for transgender
Decision Criteria
clinical Criteria
- Patient meets DSM-5 criteria for gender dysphoria.
documentation Criteria
- Explicit mention of gender dysphoria and its impact on health.
Applicable To
- Gender dysphoria in adolescents and adults
Excludes
- Gender identity disorder in children (F64.2)
Clinical Validation Requirements
- DSM-5 criteria for gender dysphoria
- Documented duration of at least 6 months
Code-Specific Risks
- Incorrect use without DSM-5 criteria documentation
Coding Notes
- Ensure documentation includes specific terms like 'gender dysphoria' or 'gender incongruence'.
Z79.890 - Hormone therapy for gender transition
Use when documenting ongoing hormone therapy as part of gender transition.
Applicable To
- Long-term use of hormone therapy for gender transition
Clinical Validation Requirements
- Prescription records
- Monitoring labs (e.g., hormone levels)
Coding Notes
Ensure prescription and monitoring details are documented.
Z87.890 - Personal history of sex reassignment
Use to document a patient's history of gender-affirming surgeries.
Applicable To
- History of gender-affirming surgeries
Clinical Validation Requirements
- Operative reports confirming prior surgeries
Coding Notes
Ensure surgical history is well-documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Transgender to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code F64.0.
Impact
Clinical: Misrepresentation of patient condition., Regulatory: Non-compliance with current coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use updated terms like 'gender dysphoria'., Regularly update coding resources.
Impact
Reimbursement: Potential claim denials due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality and inaccurate patient records.
Mitigation Strategy
Query provider for specific diagnosis details.
Impact
Reimbursement: Claims may be denied due to gender mismatch., Compliance: Failure to comply with coding rules., Data Quality: Inaccurate representation of patient care.
Mitigation Strategy
Include F64.0 to bypass gender edits.
Impact
Claims may be denied if gender mismatch is not addressed.
Mitigation Strategy
Use appropriate modifiers and condition codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Transgender, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Transgender
Use these documentation templates to ensure complete and accurate documentation for Transgender. These templates include all required elements for proper coding and billing.
Gender-affirming surgery support letter
Specialty: EndocrinologyRequired Elements
- Patient's name and DOB
- Diagnosis of gender dysphoria
- Medical necessity statement
- Informed consent
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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