Neurology & Pain Management Coding Alert

With just two codes assigned to biofeedback training, getting reimbursed seems simple. But biofeedback is confusing for coders. There are substantial differences between what Medicare and most private insurers will pay, and reimbursement rules differ among the 19 different disciplines that use biofeedback, including neurology. However, neurologists have two codes that will earn them the reimbursement they deserve if they are used correctly.

Biofeedback used to be covered under several codes (90900-90915). In 1997, the old codes were collapsed into just two that are applicable in neurology practices90901 (biofeedback training, any modality) and 90911 (biofeedback training, anorectal, including EMG and/or manometry). For starters, be sure your carrier isnt using old codes.

Its still a big problem. The newer codes have confused insurance companies as well as practitioners, says Bob Whitehouse, Ed.D, a board member of the Association for Applied Psychophysiology and Biofeedback (AAPB), and, until recently, a member of the AAPBs coding issues committee. He also serves on the associations insurance committee and is a past legislative chairman. Whitehouse is a board-certified biofeedback practitioner in the Denver and Boulder, CO, areas.

Code 90901 is always used for physician-supervised biofeedback unless the diagnosis is for incontinence (599.84). In that case, use 90911, which includes biofeedback training for the perineal muscles, anorectal or urethral sphincter, including EMG and pulsed manometry. Incontinence can be an issue for neurology patients because it is frequently associated with illnesses such as
multiple sclerosis, muscular dystrophy, lupus and strokes.
The most basic effect of the collapsed codes is that they cover all biofeedback modalities, Whitehouse says. For instance, biofeedback typically includes EMG, thermal, electrodermal, EEG, respiratory and cardiac monitors, all used simultaneously.

Some physicians mistakenly thought that a one-hour biofeedback session that included six modalities could be billed for one hour of each procedure. To carriers, however, that looked like overbillingsix hours of procedures billed for a process that took only an hour. Thats because biofeedback is typically done with a machine that simultaneously measures the various body functions that are monitored.

Some people were used to billing separately for each of these modalities and are still trying to do that, Whitehouse says. You cant do that under the new codes.
No matter how many biofeedback modalities you use, they are now reimbursed as one procedure under 90901.

Carriers will bill biofeedback in anything from one-minute increments to one hour. Medicare bills in 15-minute segments. A 15-minute billing increment is the most common, and most biofeedback sessions last 45 minutes to one hour.

Carriers Want Doctor On-site

As noted earlier, more than 19 disciplines embrace biofeedback, including dentists and psychotherapists. But with Medicare, only MD and DO practices will get paid. (There was a time when anyone who had taken a weekend course could [...]