Current medical coding system doesn't account for needs of trans patients, advocates say

Some transgender patients are denied reimubrsements for gender-affirming care by insurers because of diagnostic coding, according to a Kaiser Health News report. 

Healthcare providers in the U.S. use the International Classification of Diseases 10th Revision, or ICD-10, to submit diagnoses and procedures to payers.  

Many advocates for transgender patients say the updated version, ICD-11, includes more up-to-date and inclusive provisions for trans people, including classifying gender incongruance as a sexual health condition rather than a mental health condition. 

These classifications could make it more likely for insurers to treat gender-affirming care as medically necessary, advocates say. More than 34 countries currently use the ICD-11. 

Tim Chevalier, a trans patient in California, told Kaiser Health News about the long process to have electrolysis, a common hair removal procedure required for some gender-confirmation surgeries, reimbursed by his insurer. 

"Even though I did get reimbursed eventually, the reimbursements were delayed, and it burned up a lot of my time,” Mr. Chevalier told the outlet. “Most people would have just given up."


Read the full report here.

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