Urology Coding Alert

Biofeedback (90901 and 90911) can influence two kinds of physiologic responses: those not under voluntary control and those typically regulated but no longer regulated. Don't let biofeedback coding rules make you lose control of your reimbursements. Biofeedback for urinary incontinence defined by CMS is "a therapy that uses electronic or mechanical instruments to relay visual and/or auditory evidence to assist a person to gain pelvic muscle awareness to improve physiologic activity and bladder function."

Urinary incontinence can present in various types, including stress, urge, mixed and post-prostatectomy the most common of these being stress incontinence and urge incontinence, which are the only forms of incontinence for which biofeedback is covered, according to CMS.   Question: Are all patients covered for biofeedback?   Answer: While biofeedback coverage is at the discretion of third-party payers and non-Medicare carriers, CMS released a decision memorandum that addresses the use of biofeedback services to treat urinary incontinence on or after July 1, 2001, for all Medicare carriers.

The decision states that biofeedback is covered for the treatment of stress and/or urge incontinence in cognitively intact patients who have failed a documented trial of pelvic muscle exercise (PME) training. PME is also referred to as Kegel exercises, exercises designed to strengthen the diaphragm and pelvic floor. CMS' Coverage Issues Manual also directs carriers to cover biofeedback when it is used as "a tool to help patients learn how to perform PME." CMS defines a failed trial of PME training as having "no clinically significant improvement in urinary incontinence after completing 4 weeks of an ordered plan of pelvic muscle exercises to increase periurethral muscle strength." CMS gives carriers the discretion to determine whether biofeedback should be paid as an initial treatment modality. Be sure to check your local carrier's policy before assuming that a diagnosis code for biofeedback is covered, because even Medicare carriers vary state-to-state on their biofeedback policies, says Jackie Shovan, supervisor of billing for the division of urology at the University of Utah in Salt Lake City. For example, Cigna Medicare's biofeedback local medical review policy for Tennessee stipulates that only the following ICD-9 Codes constitute medical necessity and will be reimbursed for biofeedback:   599.82 Intrinsic (urethral) sphincter deficiency [ISD]     625.6 Stress incontinence, female     728.2 Muscular wasting     787.6 Incontinence of feces     788.30 Urinary incontinence, unspecified     788.32 Stress incontinence, male     788.33 Mixed incontinence, (male) (female)     V48.3 Mechanical and motor problems with neck and trunk     V49.2 Motor problems with limbs.   "Here in Utah, our Medicare carrier will only pay 90911 for biofeedback and will only cover 90911 when it [...]