Radiology Coding Alert

Remember the mantra: Documentation must support ICD-9 code. Whether you're coding for Medicare or a private payer, your practice should be aware of coverage requirements for the sacral nerve stimulator procedure. You can find the Medicare requirements in the Medicare Claims Processing Manual (MCPM), Chapter 32, Section 40. Medicare covers both the test and the permanent implantation to treat "urinary urge incontinence, urgency-frequency syndrome and urinary retention," but has several limitations, such as requiring the patient to demonstrate 50 percent or greater improvement with the test simulation. You can read the national coverage determination in the NCD Manual, Chapter 1, Part 4, Section 230.18, "Sacral Nerve Stimulation for Urinary Incontinence." Both manuals are available at www.cms.gov/Manuals/IOM/list.asp. Circle 788.xx to Support Medical Necessity Different payer policies reveal different ICD-9 codes that support medical necessity for the service. For example, Anthem Blue Cross and Blue Shield (www.anthem.com/medicalpolicies/policies/mp_pw_a053300.htm) lists the following [...]