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Pelvic Muscle Training for urinary and/or fecal incontinence

Heba Posted Mon 18th of June, 2018 16:55:18 PM
Would the following billing sequence be appropriate if supported by documentation: Visit 1: 99213, 51798, 81003, 97110, and 97530. Second through 6th visits as needed (treatment using electric stimulation) 91122, 51784, 97750, 97032 and 99211. Last visit 99213, 51798, 81003, 51784, and 91122.
SuperCoder Answered Tue 19th of June, 2018 06:40:23 AM

It is always better to follow a particular pattern of billing. Appropriate pattern of billing is decreasing RVU/Dollar value, means highest value code first and so on.

According to the RVU value, visit 1 sequence will be: 99213, 97530, 97110, 51798 and 81003.

For second visit: 91122, 51784, 97750, 99211-25 and 97032; in this case code 99211 is a column 2 code for 91122, use modifier 25 with code 99211 in order to differentiate between the services provided.

For final visit: 91122, 99213-25, 51784, 51798 and 81003; in this case code 99213 is a column 2 code for 91122 and 51784, use modifier 25 with code 99213 in order to differentiate between the services provided.


Hope this helps!

Heba Posted Fri 22nd of June, 2018 11:39:07 AM
Thank you. However, do these codes fit together for this type of treatment?
SuperCoder Answered Mon 25th of June, 2018 04:32:45 AM

According to the CCI edits guidelines, these codes can be billed together in order to consideration of bundling and unbundling as described earlier. For First Visit; there is no bundling in the codes; in second visit, office visit code need to append modifier 25 and in third visit too with office visit code modifier 25 need append. All above the CCI guidelines, your medical necessity should be supported by the documentation. Also, check with payer policies regarding the billed codes, if any.

Hope this helps!

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