Urology Coding Alert

Question: We have started performing biofeedback for incontinence. Can we bill the patient for the probe?

Georgia Subscriber

Answer: There is much confusion and controversy on this subject. In general, as this is a noncovered item, most carriers will not reimburse for the use of the ano-rectal or vaginal probe, yet they cost $50 to $100 each. Reimbursement varies, depending on your carrier.

Some coders state flatly that a patient is never responsible for payment of supplies relating to a Medicare-covered procedure. If Medicare covers the biofeedback, then you must pay for the probes out of your fee for the biofeedback.

Others believe that the probe cost is included in the biofeedback codes (90901, 90911) because of the difference in nonfacility and facility fees, which would imply that the supply cost is bundled into the payment for physicians. However, this difference is only $15 to $20 much less than the cost of a probe. Also, although a difference exists, probe cost does not appear to be included in the non-facility fee. Codes for urodynamics (51725-51797) include all the equipment, as stated clearly in the CPT urodynamics section. Codes for biofeedback however, make no mention of equipment. A third group of coders says you should bill the cost of the probe to DMERC, but this seems inappropriate as the probe is only for a limited treatment and not for a permanent condition. And a fourth group says to have the patient pay for the probes, using one of the two following methods:

1. Have the patient sign an advanced beneficiary notice (ABN) and hold the patient responsible for payment if the carrier refuses to pay.

2. Have the patient purchase the probe directly from the company, often at a discounted price, or from a supplier via your prescription order.

In either method, question the patients insurance company for individual protocols. Some carriers will indirectly reimburse for the probe by refunding a patients personal cost.