Billing and Coding: Posterior Tibial Nerve Stimulation for Voiding Dysfunction

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Posterior Tibial Nerve Stimulation for Voiding Dysfunction. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported. Documentation Requirements: The medical record must document the patient has OBS and not stress or neurogenic incontinence. The International Continence Society (ICS) defines OAB as the presence of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.” Compliance and voiding diaries for a minimum of three days must be kept and provided to document the patient has been compliant with first- and second-line therapies without sufficient improvement prior to receiving PTNS. Compliance and voiding diaries for a minimum of three days must be kept and provided during PTNS treatment and to document any symptoms of relapse. Utilization Guidelines: The initial 12-week PTNS treatment should be periodically evaluated to assure beneficiary improvement and record-keeping compliance. Treatments for relapse would not be expected to occur more often than one to two sessions every one to two months.