Biofeedback billing: What you need to know

November 1, 2010

Even though there is a National Coverage Decision regarding biofeedback, each Medicare carrier may approach the payment for these services differently.

The use of physical medicine codes is subject to caps under the Medicare program and may be subject to caps in other payer benefit programs as well. Be careful in using the codes, and monitor benefit caps. If a patient has exceeded a benefit cap or the plan of care exceeds the typical number of sessions, you have the option of requiring the patient to sign an Advance Beneficiary Notice and charging the patient directly using modifier –GA when reporting the services to Medicare. Neither the ABN nor the –GA modifier are required if the patient benefits are not exceeded or the treatment sessions fall within standard Local Coverage Determination parameters.

If a nurse practitioner or physician assistant is the person making the determination of the treatment session, the review by the provider for approval is governed by the state licensure requirements for non-physician providers.

Regarding who can provide these services, the services you have listed can be provided "incident to" or, if a physician or non-physician provider is present in the office and immediately available, the service can be provided by a non-physician and billed as if provided by the physician for all services listed. The two exceptions to this rule are codes 97001 and 97002, which are typically provided by a physical therapist. If the evaluation of the patient is provided by a PA, NP, DO, or MD, the evaluation, if appropriately documented, can be reported using the established patient codes 99212-99215.

Here are some special considerations for other codes used for biofeedback and pelvic floor rehabilitation:

97032: Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes. Documentation must support electrical stimulation separate from the use of biofeedback. A staff member must be present for the entire session to use this code. Note the time units and bill the appropriate number of units based on the documented time.

97110: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. Again, this service must be separately documented and supported. Biofeedback itself includes the use of a feedback monitor to help the patient determine whether she is using the correct muscles, whereas a therapeutic exercise involves continually exercising the muscle groups to build strength. Documentation for therapeutic exercise typically includes objective loss of joint motion, strength, and/or mobility (ie, degrees of motion, strength grades, levels of assistance). Note the time units and bill the appropriate number of units based on the documented time.

G0283: Electrical stimulation (unattended) to one or more areas for indications other than wound care, as part of a therapy plan of care. This is another option instead of code 97032, if the patient is not under supervision of a staff member.

97750: Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes. According to Medicare, this testing may be reasonable and necessary for patients with neurologic or musculoskeletal conditions when such tests are needed to formulate or evaluate a specific written plan of care or to determine a patient's functional capacity. Document accordingly.

Q. I am a urologist who practices in rural Oregon. I was called in to the hospital in the middle of the night to put in a Foley catheter for a patient in retention; the nurse could not insert the catheter. I had a little difficulty inserting the catheter; waiting for the hospital staff to bring up the specialty categorization cart, overall, it took me about an hour. I also drove about 30 minutes to the hospital and 30 minutes back home. I was appalled when my billing department informed me that I was paid a total of $33 for that service.

A. Unfortunately, you are not paid very well for inserting a catheter at the hospital. That payment was correct for an uncomplicated catheter insertion.

It sounds like, with the difficulty you had, and if appropriately documented, you could have charged the complicated catheterization insertion code 51703 instead of the uncomplicated code 51702. That would have increased your payment to about $91.

In addition, if you provided an evaluation and management service, you could have charged the initial hospitalization treatment code in addition to the catheterization code, if your documentation met the criteria. If you provided a lesser service, you possibly could have charged a subsequent visit instead. (Do not forget to add the –25 modifier to the E&M code.) Still not good, but better than $33.

Disclaimer: The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook. Mark Painter is CEO of PRS Urology SC in Denver.