Q If a patient is on metformin for insulin resistance, what is the diagnostic code for insulin resistance if the patient is not pregnant? She will be undergoing in vitro fertilization.
A Metformin is generally used as an oral agent to help control type 2 diabetes, but your question suggests another use for the drug. Recent evidence indicates that metformin may facilitate ovulation in some women with polycystic ovary syndrome (PCOS) when taken in combination with clomiphene. Since the PCOS usually causes the insulin resistance that may, in turn, cause the infertility, I would suggest PCOS (ICD-9-CM 256.4) as the most accurate diagnosis. Still, infertility remains the primary diagnosis, which means you’ll need to list code 628.0 (female infertility associated with anovulation) first on the claim.
This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.