Urology Coding Alert

As biofeedback training for the treatment of urinary incontinence is gaining in popularity with urologists, more billing managers are experiencing difficulty getting full reimbursement for this procedure.

The following seven steps will enhance your chances for payment:

1. Use code 90911: The code 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) has been allotted to the procedure of biofeedback to treat urinary incontinence. Some coders use 90901 (biofeedback training by any modality) to treat urinary incontinence. And some practices add the 51784 code (electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) when an EMG is performed. However, Lisa Harris, CPC, a urological coding specialist at Gaston Urological in Gastonia, NC, points to the danger of unbundling and advises practices to use the 90911, which already includes the EMG.

2. Use the proper diagnosis codes: Careful selection of the ICD-9 diagnosis code shows the medical necessity of the biofeedback training on a patient-by-patient basis. Have the physician in your office submit detailed notes outlining the medical necessity. For example, diagnosis codes such as 625.6 (stress incontinence, female) or 788.35 (post-void dribbling) clearly warrant biofeedback treatment. ICD9 codes should be double-checked to confirm that the condition could call for biofeedback treatment.

Medicare is more conservative in its reimbursement than most private carriers, so pay attention to the specific diagnosis code used (See box below). Even Medicares requirements vary from state to state, with some states covering up to 10 diagnoses and others just four or five. Most states are reviewing their requirements this year and are considering more liberal reimbursement because biofeedback is becoming a more widely accepted modality with more evidence of its clinical efficacy.

3. Physician on premises: While the physician doesnt have to actually administer the biofeedback sessions, Medicare and most private carriers require the urologist to have a continuous presence.

That means the physician must be on the premises, says LaWana Heald, an independent billing consultant in Anaheim, CA, who teaches seminars on biofeedback coding. They dont have to be in the same room. But the physician should have done the initial evaluation, set the guidelines for the treatment program, and reviewed the process with the biofeedback therapist.

4. Educating the payer: Unfortunately, a stigma is attached to biofeedback training, according to George F. Alex, CPC, a medical coding instructor at Johns Hopkins School of Medicine, and managing partner of Iatro, LC, a Baltimore, MD based consulting firm, When payers see 90911, they are often envisioning a procedure much different than the one [...]