Refer to the Novitas Local Coverage Determination (LCD) L34977, Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters, for reasonable and necessary requirements.
The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
Coding Information
CPT codes 91122 or 51784/51785 should be billed during the initial diagnostic evaluation only when the cause of the fecal incontinence or urinary incontinence cannot be determined from the physicians’ evaluation and that the physician has determined that diagnostic testing is needed to make a diagnosis.
CPT code 91122 should not be billed when the physician is trying to evaluate urinary incontinence.
Consistent with the direction in the Utilization Guidelines of L34977, CPT codes 51784, 51785 and 91122 should not be reported more than once per year. CPT codes 90901, 90912 and 90913 may be reported up to 4 times per year.