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Posted By dawn b on 01-30-2019, 07:33:27 in Urology
I am having some trouble finding correct and complete coding for these procedure codes done for Urinary incontinence, especially from medicare, : 99211 (1st visit), 51784-5 (first and last visit) 90911,97750-gp, 97032-gp. There are two other codes: g8990 (modifiers ch-cn) and g8992. What is correct for non medicare and medicare??? Please help because this is very confusing. I've consulted AUGS already Thank you
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Posted By Melanie Witt on 02-03-2019, 16:00:16
Code 51784 cannot be billed with 90911 as it is included per the description of code 90911. If this is what is being done, they only bill 90911 for the biofeedback with urostim treatment. The E/M is also not separately billable unless it is separate and significant from the biofeedback procedure (and 99211 is certainly to a significant service). 97750 is also bundled into 90911 so you would have to show that is was a distinct procedure from using the urostim in addition to the biofeedback. 97032 is not bundled, but what additional electrical stimulation is going on that has been documented. Again, using the urostim with biofeedback is intuitively covering the service, but you must also check with documentation for what has been separately documented in order to tack on this code (and remember that 90732 is the code used for constant attendance and time would also have to be documented. As to the G codes, you have listed, these were never billing codes, but rather they were used to report quality data that rehab therapy providers—including eligible physical therapists, occupational therapists, and speech-language pathologists—included on their Medicare claim forms to fulfill requirements for Functional Limitation Reporting (FLR). CMS originally used this code set to track information about Medicare beneficiaries’ function and condition. G-codes were also used to report for PQRS—a defunct quality-reporting program—until January 1, 2017. While these code are still valid, Medicare no longer requires reporting them and they will be phased out by next year.

There are no shortcuts to figuring out how to bill for biofeedback with urostim with commercial payers. You need to find out their policies and then abide by them. And keep in mind that even if a payer gives you a list of codes that could be billed, it does not mean you get to bill all of them for any given date of service.
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