Radiology Coding Alert

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.

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 codes in its policy:

• 788.20-788.29 -- Retention of urine
• 788.31 -- Urge incontinence
• 788.41 -- Urinary frequency
• 788.63 -- Urgency of urination.

PBSI Medicare Services for Arkansas lists many of the same codes with a few additions (www.arkmedicare.com/provider/viewarticle.aspx?articleid=6335):

• 596.52 -- Low bladder compliance
• 596.55 -- Detrusor sphincter dyssynergia 788.20-788.29
• 788.30 -- Urinary incontinence, unspecified 788.31
• 788.33 -- Mixed incontinence (female) (male)
• 788.64 -- Urinary hesitancy
• 788.91 -- Functional urinary incontinence
• 788.99 -- Other symptoms involving urinary system.

Remember: "It is illegal to just assign an ICD-9 code that will get your claim paid -- you have to report the codes documented in the record," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. Any diagnosis that you report on a claim must be clearly documented in the patient's chart -- not selected because it's a covered diagnosis.