Urology Coding Alert

Question: We are having trouble getting paid for biofeedback training (90901-90911) and biofeedback physical (97750) from Medicare. What are some tips on how to bill those codes? I use the ICD-9 codes 728.2 and 787.6.

Florida Subscriber

Answer: The correct diagnosis code to report for biofeedback training should be based on the patients condition as documented in his or her medical record.

Most carriers and intermediaries consider ICD-9 code 728.2 (muscular wasting and disuse atrophy, not elsewhere classified) to be a covered diagnosis for 90901 (biofeedback training by any modality) and also consider 787.6 (incontinence of feces) to be a covered diagnosis for 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry).

Because 90911 represents a specific biofeedback method that is a more involved procedure than other conventional biofeedback methods, you should not normally report 90901 and 90911 together. Code 97750 (physical performance test or measurement [e.g., musculoskeletal, functional capacity], with written report, each 15 minutes) should be used to report extensive testing with resultant measurement, in the form of a written report, of strength and functional and physical performance. Code 97750 is bundled into the biofeedback service for Medicare purposes, and separate payment would depend on the use of modifier -59 (distinct procedural service). It is usually used to evaluate rehabilitative progress and must be performed by a physician or registered physical therapist.

To report the physical assessment of a patient for biofeedback training, identify the service with an appropriate evaluation and management (E/M) code (using the key components to identify the level of service that should be reported). Note that appropriate key components for the level of E/M chosen (history, exam and medical decision-making) must be performed to report an E/M code. You should contact your carrier to verify whether it has a specific local medical review policy (LMRP) on biofeedback.