Healthcare Fraud Shield’s Latest Article: Controlling the Uncontrollable?

5 Nov
Do you ever use Fitbit’s Relax feature which provides guided breathing sessions? While in this mode, the user can concentrate on clearing his/her mind, lowering the heart rate and as the feature suggests, just relaxing.     Certain bodily functions such as your heart rate, blood pressure, skin temperature are controlled involuntarily by our nervous system.   Using the Fitbit or other similar devices to help control some of these areas is akin to what we know in the medical field as biofeedback.   According to WebMD1:

 

The idea behind biofeedback is that, by harnessing the power of your mind and becoming aware of what’s going on inside your body, you can gain more control over your health.
 
How is Biofeedback performed?
Although methods vary slightly, typically a biofeedback therapist will attach electrodes or sensors to the skin to monitor things such as blood pressure, heart rate, skin temperature, peripheral vasomotor activity and more. The therapist utilizes a variety of techniques such as deep breathing, progressive muscle relaxation, guided imagery and mindful medication.2
 
Why is Biofeedback performed?
A variety of conditions may warrant utilizing biofeedback including, but not limited to:
  • Constipation
  • Incontinence
  • Migraines
  • Neuromuscular rehabilitation for patients who had a stroke
How is it billed?
These are the codes that can currently be used:
  • E0746 – Electromyography (EMG), biofeedback device
  • 90901 – Biofeedback training by any modality
  • 90911 – Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry
CPT 90911 will be deleted effective 12/31/2019 and replaced with two codes:
  • 90912- Biofeedback Training, Perineal Muscles, Anorectal Or Urethral Sphincter, Including Emg And/Or Manometry, When Performed; Initial 15 Minutes Of One-On-One Physician Or Other Qualified Health Care Professional Contact With The Patient
  • +90913 – Biofeedback Training, Perineal Muscles, Anorectal Or Urethral Sphincter, Including Emg And/Or Manometry, When Performed; Each Additional 15 Minutes Of One-On-One Physician Or Other Qualified Health Care Professional
Is Biofeedback a covered service?
Typically, biofeedback is covered by health insurance when performed by a licensed provider for a limited number of conditions such as:
  • Chronic constipation
  • Fecal incontinence
  • Stress urinary urgency
  • Migraine and tension headaches
  • Muscular re-education after a stroke

It is considered experimental, investigational and unproven for conditions such as:

  • Autism
  • ADHD
  • Spasmodic torticollis
  • Epilepsy, etc.3
What to look for?
  • Inappropriate medical diagnoses to support the service
  • Excessive time submitted for the new add-on code
  • Providers hiding these services under other codes when performing them for the for conditions that are considered investigational.4
If you have any questions or comments, please contact SIU@hcfraudshield.com.

REFERENCES


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