Urogynecological Medical Coding: Sure-fire Coding Tips on Biofeedback


 

If you're doing biofeedback training for bladder symptoms especially frequency and incontinence, you should use the code 90911 which is a code specific for training of perineal and the urinary sphincter muscular tool. Read this expert coding and compliance article for more.

Notice that we added the GP modifier for payment purposes. The GP modifier indicates that this service was provided by a physical therapist which is usually not the case in the urology office or it's provided under an outpatient physical therapy plan of care which is what the urologist is doing.

Note that the code 90911 includes many other medical coding options. It includes the EMGs both the 51784 and 51785. And this should not be billed as part of biofeedback training. The one code that is used frequently and is paid when unbundled is the 97032 which is an assisted stimulation by electricity of the various muscle.

If you do an E&M service with the biofeedback in line with the medical coding rules, the E&M services are not bundled with the 90911 and you do not need any modifiers. Now, your diagnoses for biofeedback bladder training are stress incontinence, urgency incontinence, mixed incontinence 788.33 and overflow incontinence 788.38.

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You certainly should have precertification from the carrier to perform a biofeedback. And you should have eurodynamics at least on the chart if requested. Most biofeedbacks are performed by a nurse or a trained medical technician. However, the doctor must be in the office in the office suite to bill for this billing under a plan of a direct supervision.

The biofeedback can be performed in the office, in the outpatient, in the emergency room but biofeedback performed at home is not a payable service.

Medical Coding and Billing Tip: Certainly carriers have certain restrictions at how frequent they will allow your biofeedback bladder training. Anywhere from four to six months per year and you should certainly consult with your carrier to find out how often they will allow biofeedback.

You may try to bill for a surgical tray A4550 and 99070. Medicare will not pay for these at all. Some carriers will pay for the surgical tray. Usually the probe used is not paid but if you have a durable medical equipment regional number, you may want to bill using the E-codes.

Get more information urogynecological coding updates, visit our medical coding conference page.

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