Urology Coding Alert

Remember these situations, simplify your coding.

CMS defines biofeedback for urinary incontinence as “a therapy that uses electronic or mechanical instruments to relay visual and/or auditory evidence to assist a person to gain pelvic muscle awareness to improve physiologic activity and bladder function.” The condition can manifest in several forms, but the most common are stress incontinence and urge incontinence – the only forms of incontinence for which CMS covers biofeedback treatment.

Round out your coding knowledge by checking the answers to these top questions.

Question 1: Are all patients covered for biofeedback?

Answer 1: It depends. Biofeedback coverage technically is at the discretion of third-party payers and non-Medicare carriers. However, CMS released a decision memorandum that addresses the use of biofeedback services to treat urinary incontinence on or after July 1, 2001, for all Medicare carriers. According to the memo, biofeedback is covered when used to treat stress and/or urge incontinence in cognitively intact patients who have failed a documented trial of pelvic muscle exercise (PME) training.

CMS’s Coverage Issues Manual also directs carriers to cover biofeedback when it is used as “a tool to help patients learn how to perform PME.” A failed trial in CMS’s view is a time of PME training after which the patient shows “no clinically significant improvement in urinary incontinence after completing 4 weeks of an ordered plan of pelvic muscle exercises to increase peri-urethral muscle strength.”

Question 2: Does the physician have to administer the biofeedback, or can a nurse administer biofeedback and will the physician still be reimbursed?

Answer 2: All Medicare carriers and many third-party payers allow coverage for medically necessary biofeedback training when performed by a physician, by a qualified non-physician practitioner, or a nurse under the “direct supervision” guidelines. Direct personal supervision in the office setting means the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services in case a problem arises. The physician does not have to be in the room where the study is being performed, but he must be in the office suite.