Ob-Gyn Coding Alert

Before turning to surgical treatments for stress urinary incontinence (SUI), ob-gyns generally attempt to treat the condition with nonsurgical methods. These treatments provide their own coding dilemmas.
 
One of the most common nonsurgical treatments for incontinence is to educate the patient to rehabilitate her pelvic floor muscles. A common exercise is Kegels, which increase the pelvic floor's muscle volume and develop stronger reflex contractions following a quick rise in intra-abdominal pressure - the precipitating factor in stress incontinence. Kegel instruction takes more than a brief verbal explanation or an educational pamphlet. The provider also instructs the patient how to use biofeedback techniques.

Remember Whom You're Coding For

If a nurse is providing incontinence counseling, you can report it with 99211, says Peggy Stilley, CPC, CAPPM, CMC, practice office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa. You may report 99212-99214 if a physician, physician's assistant or certified registered nurse who is credentialed as a provider performs the service, she adds.
 
If the training involves biofeedback, you can report 90911 (Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry). Remember, however, that many payers assume that a physician provided the service when you use this code. So, if a nonphysician practitioner performs the biofeedback training, check with your carrier to determine how you should report this service, says Connie Craig, CPC, an associate consultant with RSM McGladrey in Kansas City, Mo.
 
Along with exercises, ob-gyns often use small vaginal cones for pelvic floor rehabilitation. The cones allow the patient to specifically identify and exercise these muscles. Showing women how to use and clean the cones takes roughly 15 to 30 minutes and may involve additional counseling. When coding for this service, you should report an E/M service (such as 99211) as well as the supply code (99070, Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), Stilley notes.
 
Another treatment is the electrical stimulation of the pelvic floor. This improves continence by increasing urethral closure pressure. If the physician performs the electrical stimulation, you should use 64550 (Application of surface [transcutaneous] neurostimulator) for surface neurostimulator placement or 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerves [excludes sacral nerve]) for intravaginal stimulator placement. If the nurse performs the service, report 97014 (Application of a modality to one or more areas; electrical stimulation [unattended]) if there is no constant physician attendance, or 97032 (Application of a modality to one or more areas; electrical stimulation [manual], each 15 minutes) if there is.