Urology Coding Alert

In the March issue of Urology Coding Alert, the cover article Get Reimbursed for Biofeedback Incontinence contained three points that need clarification:

1. Pretreatment testing. We stated that Medicare requires urodynamics testing (51726 and 51741), bladder scans (G0050), VP studies (51795), or intra-abdominal voiding pressure studies (51797) before beginning biofeedback therapy. Actually, pre-biofeedback testing and evaluation services are carrier-specific, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a Denver-based coding, compliance and reimbursement consulting company. There is no Health Care Financing Administration (HCFA) policy at this time regarding specific clinical guidelines for the treatment of incontinence (or other muscle re-education) with biofeedback, says Page. Good medicine would dictate the necessity of the diagnostic workup in order for the physician to determine if the patient would even benefit from biofeedback treatments. No physician, Page explains, would perform a procedure without completely evaluating the patient first.

2. Frequency of sessions. Depending on your carrier, you may be able to treat a Medicare patient more than six times and a commercial patient more than three times with biofeedback. However, you also may find you have tighter restrictions. Our source for the frequency limitations is based in New York State.

3. Electromyography (EMG) and 90911. We stated that CPT code 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry) includes EMG (51784, 51785). The code actually includes EMG and/or manometry. But the EMG is included in 90911 when the purpose of the EMG is used to provide feedback. You cannot bill 90911 with an EMG even with modifier -59 (distinct procedural service).

Note: Biofeedback and the gamut of urodynamics studies have different requirements based on carrier. Check with your carrier first.