Ob-Gyn Coding Alert

Break down how each type of provider should code for PFMR.

Before turning to surgical treatments for stress urinary incontinence (SUI), many urogynecologists may attempt to treat the condition with nonsurgical methods. These treatments provide their own coding dilemmas. Check out how you should report pelvic floor rehabilitation (PFMR) services.

What it is: PFMR is a non-invasive, painless treatment option for a wide range of bladder issues, which comes with a 70-80 percent success rate of significantly improving symptoms and has no side effects. PFMR re-educates and tones the muscles in the pelvic floor, which in turn can positively affect general bladder function. 

Tip 1: Determine Who Can Perform PFMR

This service can be performed by a physician, physical therapist (PT), registered nurse (RN), or a medical technologist (MT). However, the latter three of these must have been trained in an accredited PT program.

Tip 2: Separate Out E/M Services

If your provider also performs an E/M service, you can bill them with the PFMR if a separate and significant evaluation and management service has been documented. If the trained therapist performs the PFMR and the physician performs the problem evaluation, the PFMR can be considered “incident to” services. Keep in mind that the urogynecologist needs to be in the office with they are taking place. In other words, you need to confirm direct supervision.

Tip 3: Have This Support for PFMR

Sometimes, you need to justify PFMR. Here are some requirements you may encounter.

The patient must have failed 4 weeks of ordered and supervised pelvic muscle evaluation (PME).

Diagnoses that support PFMR may include:

• 625.6, Stress incontinence female
• 788.31-788.33, 788.38, Urinary incontinence …
• 788.41, Urinary frequency
• 788.43, Nocturia
• 618.83, Pelvic muscle wasting
• 625.8, Other specified symptoms associated with female genital organs (used to report muscle spasms of the perineum).

You should note that some payers have incorrectly identified 728.3 (Muscular wasting and disuse atrophy not elsewhere classified) as an approved diagnostic indication for PRMR despite the fact that a more specific code directly related to pelvic muscle wasting is available.

Check Out This Coding Examples

Usually 6 to 8 sessions are payable by Medicare and other non-Medicare payers.

Append modifier GP (Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care)) as explained and shown below to all PT code services provided. The following are recommended coding scenarios for PFMR based on the services provided:

The American Physical Therapy Association (APTA) recommends the following codes for a physical therapist or a provider within the scope of practice:

97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility),

97112 (Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities), and 

97530 (Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes).

The American Urological Association (AUA) and APTA recommend:

51784 (Electromyography studies (EMG) of anal or urethral sphincter, any technique) for the initial assessment, and

90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry), 97032 (Application of a modality to 1 or more areas; electrical stimulation [manual], each 15 minutes), and 91122 (Anorectal manometry) for the last visit involving the evaluation of treatment. 

Careful: The code 91122 represents a study that is done to assess the patient with fecal incontinence, not urinary stress incontinence.  This condition must be documented in the record in order to bill this study.

According to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook, “My personal billing for PFMR for which I have been paid is as following:

• 97032-GP
• 97110-GP
• 97750-GP (Physical performance test or measurement [e.g., musculoskeletal, functional capacity), with written report, each 15 minutes).”