Urology Coding Alert

Now that Medicare allows coverage for the probe for pelvic floor therapy, and some carriers are covering the therapy itself, urologists should know how to code these procedures. Although biofeedback (90901 or 90911) and electrical stimulation (97032 or 97014) are popular with patients, you wont gain much reimbursement for these labor-intensive, low-paying procedures. But if you do your research and bill according to accepted protocol, providing the services could be worth the effort.

Biofeedback and electrical stimulation treat urinary incontinence, a condition affecting 17 million adults. Nearly 35 percent of female and 25 percent of male Medicare patients have urinary incontinence (either stress, urge, a combination of the two or, more rarely, post-prostatectomy). Stress incontinence is due to inadequate urethral pressure; the patient loses urine during sneezing or other exertion. Urge incontinence is the involuntary loss of urine due to abnormal bladder contractions. Treatments include behavior therapy, medication, nerve stimulation, electrical and magnetic simulation and surgery. Many candidates for biofeedback have already had surgery.

Virtually all payers demand that the patient perform the first primary treatment for urinary incontinence at home. The patient does Kegel exercises (technically called pelvic muscle exercises, or PME) to strengthen the pelvic floor diaphragm. Payers will not cover biofeedback or electrical stimulation unless the patient has completed a PME trial without positive results (defined as no clinically significant improvement in urinary continence after completing four weeks of an ordered plan of pelvic muscle exercises designed to increase periurethral muscle strength).

Whether Kegel exercises alone are as effective as biofeedback with Kegel exercises is still a controversy. Medicare, however, will pay for Kegel exercises with biofeedback, but not for Kegel exercises (which are done by the patient at home) alone.

The American Urological Association rates biofeedback between level three (effective with advantages) and level four (effective with no advantages) using Medicares rating scale. Not all studies have found biofeedback to be more effective than PME alone, but HCFA allows coverage for biofeedback, at the discretion of Medicare contractors, as an initial therapy. As stated in the amended coverage issues manual (CIM), Contractors may decide whether or not to cover biofeedback as an initial treatment modality.

Coding for Biofeedback and Electrical Stimulation

Urology coders can choose only one of the two codes for biofeedback: 90901 (biofeedback training by any modality) or 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry). Check with your carrier to see which code it prefers.

Jackie Shovan, CPC, financial counselor for the division of urology at The University of Utah in Salt Lake City, says that recently her carrier, which pays for 90911 but not 90901, has been requesting documentation of the entire medical process: You [...]