# Urostym



## Chelschambers (Nov 14, 2016)

We were approached by a representative with Laborie regarding a device called Urostym.    He stated if we had our own Urostym device and equipment we could bill for pelvic muscle rehab in our office.  We were informed an RN or even an MA could perform the muscle rehab with the Urostym equipment and it is approved by CMS.

The specific CPT codes we were given are listed below.   Please let us know if you have any information and guidelines related to the Urostym and its billing requirements.

Thank you so much!





Procedure-----1st Visit	
91122	Anorectal Manometry
99211	Office Visit


Procedure-----2nd Visit	
51784	EMG
99211	Office Visit
97032-GP	Electrical Stimulation


Procedure-----3rd Visit	
91122	Anorectal Manometry
99211	Office Visit
97032-GP	Electrical Stimulation


Procedure-----4th Visit	
51784	EMG
99211	Office Visit
97032-GP	Electrical Stimulation

“Prior to implementing biofeedback the patient must have failed a 4 week trial 
of prescribed pelvic floor muscle exercise.” [CMS Guidelines]

Procedure ----5th through 8th visits
90911	Biofeedback
97750-GP	Physical Performance
97032-GP	Electrical Stimulation
99211	Office Visit


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## kendrahawkins (Nov 14, 2016)

Hi- we do pelvic floor therapy in our office and the coding you have below is how we code for medicare patients. Private insurances (in my area) are billed all the codes (that are done) every visit.
Hope this helps!


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## nrood (Feb 12, 2020)

Hello! We just started using the Urostym device and we are really confused about the billing for the services. Our Urogynecologist is treating for urge incontinence. Per guidance above, it says to use the 91122 for the first visit. However, the Medicare LCD states that the 91122 should not be used to evaluate urinary incontinence and should NOT be reported more than once per year. Our take of the LCD, is that the 91122 should be used for diagnosis such as fecal incontinence or constipation. Also, per our coding software (Optum) it describes the procedure as:  "A manometry probe is advanced into the rectum after a digital exam. The probe is slowly withdrawn, taking continuous pressure measurements until the high pressure area of the anal sphincters is located. With the patient relaxed, the "basal anal pressure" is recorded, and highest pressures are recorded as the patient performs a maximum squeeze. The manometry catheter is inserted again with a rectal balloon that is slowly inflated to the patient's first sensation of fullness and the volume is recorded. The anal sphincter response to the rectal distention is also recorded." Our provider is not really doing that part. Our documentation reflects that the abdomen is prepped and surface electrodes are placed on rectus abdominus muscle. Internal sensor is placed in the vagina and a rectal manometry sensor is inserted through the rectal sphincter.  The patient is then asked to contract their pelvic floor muscles for 10 secs and then relax 10 secs for 20 reps (or until fatigue). He then assesses the repetitions and amount of time they can hold the contractions. Based on this, he decides if they need PF training and gives them an exercise prescription. Can someone, please, shed some light on this? I would really appreciate it!! Also, if you are following the guidance above, are you having issues with Medicare paying on the 3rd visit when another 91122 is being billed?


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