Pelvic Floor Rehab


Newburgh, IN
Best answers
Our NP is starting a Pelvic Floor Rehab in our urology group. The Doctor is seeing the patient then refers to NP to initiate the rehab. She wants to charge an office visit with 25 modifier with each session which includes 51784 or 90911, 97032, 97110, 97530. Any thoughts on this?
I would say unless she is addressing something separately identifiable from the Biofeedback or the patient is experiencing difficulty with biofeedback she should not bill an office visit in addition.

The patient was referred to the NP for a specific service. The referring provider in your office has already documented the clinical situation for the patient and the reason for ordering biofeedback. No additional E&M would be warranted unless a new issue arises and is documented appropriately by the NP. The discussion of the biofeedback services and regular progress would not warrant a seperate E&M.

The use of modifier 25 has specific guidelines and should not be used to simply bypass payer edits. Retrospective audits could prove to be costly to a practice when proper use of modifers are not followed.

Review and share the requirements of modifer 25 with your NP. That will help her understand when to bill an E&M in addition to other services on the same day, and when not to.

Good Luck!