Remark code N86 indicates that coverage for biofeedback training as a treatment for urinary incontinence is contingent upon the patient having first attempted and failed a trial of pelvic muscle exercise training. If the required trial has not been documented or completed, reimbursement for the biofeedback training may be denied.
Common causes of code N86 are:
1. Lack of documentation proving that a trial of pelvic muscle exercise training was attempted before biofeedback training.
2. Insufficient trial period of pelvic muscle exercises prior to initiating biofeedback training.
3. Biofeedback training for urinary incontinence started without a prior recommendation for pelvic muscle exercise training.
4. Claims submitted without the required evidence or certification that pelvic muscle exercise training was unsuccessful or not tolerated by the patient.
5. Incorrect coding or billing that fails to reflect the prerequisite trial of pelvic muscle exercises.
6. Inadequate communication between healthcare providers and billing personnel, leading to a misunderstanding of the coverage requirements for biofeedback training.
Ways to mitigate code N86 include ensuring that documentation clearly reflects a patient's completion of a pelvic muscle exercise training trial without satisfactory improvement before proceeding with biofeedback training. It's important to maintain detailed records of the exercise regimen, duration, and patient responses. Additionally, healthcare providers should educate patients on the importance of adhering to the prescribed exercise program to demonstrate the necessity of advancing to biofeedback training for their condition. Regularly reviewing treatment protocols to ensure they align with coverage requirements can also help prevent this code from arising.
The steps to address code N86 involve verifying that the patient has indeed completed a failed trial of pelvic muscle exercise training prior to receiving biofeedback training for urinary incontinence. To resolve this issue, you should:
1. Review the patient's medical records to confirm whether a trial of pelvic muscle exercise training was conducted and document the outcome.
2. If the trial was completed and failed, ensure that this information is clearly noted in the patient's records and that the documentation supports the necessity for biofeedback training.
3. Update the claim with the appropriate documentation or a narrative description that provides evidence of the failed trial.
4. Resubmit the claim with the additional information to the payer for reconsideration.
5. If the trial was not completed, work with the patient's healthcare provider to initiate the required pelvic muscle exercise training before biofeedback is attempted again.
6. Monitor the patient's progress and maintain communication with the provider to ensure that the results of the trial are documented and can be submitted with future claims if necessary.
By following these steps, you can ensure that the requirements set forth by the payer are met, and the claim for biofeedback training can be processed appropriately.