Urology Coding Alert

The key to reimbursement for biofeedback treatment is the work you must do prior to the biofeedback itself. This is because Medicare and commercial payers want to make sure that the patient is a good candidate for biofeedback.

Biofeedback for incontinencecode 90901 (biofeedback training by any modality) and 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry)is a new therapy that patients prefer to surgery and many insurance companies pay for because, with limits on the number of sessions, biofeedback is a lot less expensive than surgery.

Stella Natarova, CPC, CCS-P, director of compliance and reimbursement for Adult and Pediatric Urology Group of Maryland in Baltimore, says you need to pick the biofeedback code based on what kind of biofeedback you do. With a vaginal or rectal probe the patient practices moving muscles, and the urologist checks the biofeedback screen to tell the patient when the right muscles are being moved, Natarova explains. Another type of biofeedback training includes electromyography (EMG). With EMG, a needle registers how the muscle moves. Sometimes only a vaginal or rectal probe type of biofeedback is done without EMG. In this case, you cant use 90911, because that requires EMG. Code 90911 pays better because it is a little more invasive, Natarova notes.

Prebiofeedback Testing

You have to exhaust all other avenues before anyone will pay for biofeedback, says Jackie Shovan, CPC, financial counselor at the division of urology at the University of Utah in Salt Lake City. Thats because some payers dont think biofeedback is all that effective. Shovan cautions that once you start doing biofeedback for incontinence, auditors will come in and make sure you are doing all of the pretreatment testing. Some want you to try all the medications first, too.

There are several steps a urologist must take before conducting biofeedback treatment. The first office visit is likely to be a consultation (99241-99245). Then, based on the doctors findings, he or she proceeds with prebiofeedback testing. You need to do a full urodynamics workup before Medicare or commercial payers will pay for the biofeedback, says Ruth Borrero, assistant billing manager specializing in Medicare reimbursement for Urology Associates, an eight-provider practice in Manhasset, N.Y. Here are the tests that need to be done:

1. Complex cystometrogram. 51726 (complex cystometrogram [e.g., calibrated electronic equipment])

2. Complex uroflowmetry. 51741 (complex uroflowmetry [e.g., calibrated electronic equipment])

3. EMG studies. 51784 (electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique)

4. VP studies. 51795 (voiding pressure studies [VP]; bladder voiding pressure, any technique)

5. Intra-abdominal voiding pressure. 51797 (voiding pressure studies [VP]; intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]).

Depending on the patient, [...]