Determining the correct code for urinary incontinence
Your patient just presented with urinary incontinence. It’s been a while since you’ve had to recall the different types of urinary incontinence, not to mention the treatment options, device reimbursement qualifications, and urinary incontinence ICD 10 coding. Here’s a quick refresher of the most common types of incontinence:
- Stress urinary incontinence (N39.3) is an involuntary loss of urine with a sudden increase in abdominal pressure. These patients leak when they sneeze, laugh, cough, or exercise. It is the most common type of incontinence. It affects women more frequently than men, often starting after the trauma of childbirth.
- Urge urinary incontinence (N39.41) occurs when patients have a sudden urge to urinate and subsequent loss of bladder control. It is associated with detrusor muscle hyperactivity. Urge incontinence occurs in both men and women, with a higher incidence among the elderly.
- Mixed urinary incontinence (N39.46) presents with symptoms of both stress and urge incontinence. It is more common to have mixed incontinence than to have solely urge incontinence.
- Overactive bladder (N32.81) is basically urge incontinence without the leaks. These patients are quick enough and mobile enough to get to the toilet before having an accident.
Other types of incontinence include overflow incontinence, functional incontinence, and variations of fecal incontinence. Each type has its own urinary incontinence ICD 10 code.
Did I prescribe the right treatment?
When you’ve diagnosed the patient and figured out the correct urinary incontinence ICD 10 coding, it’s time to recommend an appropriate treatment. Primary care physicians and gynecologists may not be familiar with all the at-home options to treat their stress urinary incontinence patients. Typical suggestions include Kegel exercises and limiting fluid intake, and currently, there are no medications approved to treat stress urinary incontinence. Invasive treatments include surgery, internal tissue manipulation, and intravaginal monitoring and stimulation, plus these treatments typically require a specialist’s care.
For patients with mild to moderate incontinence symptoms, it may be preferential for the primary care physician or gynecologist to provide conservative care directly. This approach results in more immediate care for the patient, continuity of care to monitor progress, and minimized costs.
What are conservative, noninvasive treatments for stress urinary incontinence?
Several FDA-cleared, in-home options are available to treat stress urinary incontinence. These devices use electrical stimulation (“e-stim” or sometimes called TENS) to exercise the pelvic floor muscles, using either internal or external probes. An internal e-stim device consists of a probe that the patient inserts into her vagina. This device delivers a stimulation designed to contract and relax the pelvic floor. After several weeks of treatment for 20–30 minutes per day, most women see a reduction in urine leaks. External e-stim devices achieve similar results but are much less invasive. E-stim is sent through the skin, without vaginal insertion. FDA-cleared ELITONE is an external e-stim device that delivers stimulation through disposable GelPads that fit like sanitary pads.
ELITONE and other external devices are a good fit for women who:
- Are resistant to intravaginal treatments.
- Want to supplement or have limited access to pelvic floor physical therapy.
- Have trouble performing Kegel exercises correctly (1 in 4 women).
- Prefer the convenience and privacy of in-home treatment.
- Need care after their 6-week postpartum checkup.
Is ELITONE covered by insurance?
In addition to determining the correct urinary incontinence ICD 10 code, treatment devices correlate with certain codes. HCPCS code E0740 applies to “non-implantable pelvic floor muscle stimulators,” including ELITONE. Note that PDAC (Pricing, Data, Analysis and Coding Contractor) recently reviewed this code and found that many previously covered devices, specifically those that provide biofeedback (i.e., electromyography) but do not provide e-stim, do not fall within the scope of E0740 and are not covered. To fall within the category of the code, the device must deliver stimulation that exercises the pelvic floor muscles.
ELITONE received approval to utilize E0740 shortly after it received FDA clearance. Many private insurers cover ELITONE and have published coverage decisions (e.g., United Healthcare). Although requirements vary, most insurers have two stipulations: a prescription and failed improvement with four weeks of pelvic floor exercises.
Unlike other e-stim devices, ELITONE is also available as an FDA-cleared, over-the-counter (OTC) product and can be purchased by patients directly from the ELITONE website. This is an excellent solution for patients without insurance coverage or who want immediate access to treatment.