Hi, we register the patient based on gender at birth and preferred gender. When it comes to billing it is tough but we have to change the sex to get the bill dropped and then change it back. We have what are called special indicators in our EMR that give patients like this a specific alert for all users. It is definitely not an easy process because our EMR does not allow for any of these special cases. It is a lot of manual work. Hope this helps.
I am not familiar with condition code 45 but I do understand from the coding area that sometimes we get rejections, while other times we do not. It depends on the insurance carrier. It is a crap shoot at this time.