CPT® Code 90911

Code deleted, see 90912, 90913

Official Description

Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry

Common Language Description

Biofeedback training for the perineal muscles, specifically targeting the anorectal or urethral sphincter, is a therapeutic procedure designed to assist patients in managing various conditions related to urinary and fecal control. This training is particularly beneficial for individuals experiencing urinary retention, urinary incontinence, fecal incontinence, or constipation. The procedure incorporates advanced techniques such as electromyography (EMG) and manometry, which are essential for monitoring and providing feedback on muscle activity. During anorectal biofeedback, a specialized manometer probe equipped with multiple microsensors and a balloon, or alternatively, a water-perfused probe with side holes, is utilized. These devices are instrumental in delivering real-time visual or auditory feedback regarding the muscle activity of the abdomen, rectum, pelvic floor, and anal sphincter. This feedback is crucial for identifying dyssynergic muscle activity, which can hinder normal defecation. Through the application of neuromuscular conditioning techniques, patients learn to enhance the coordination of their anorectal muscles. In cases of bladder sphincter dyssynergia, biofeedback training involves specific exercises aimed at tensing and relaxing the pelvic muscles, alongside practicing relaxation techniques during voiding. Additionally, a biofeedback device that records urinary flow and EMG data, accompanied by a visual display, is employed to inform the patient of any changes in pelvic floor and urethral sphincter tension. By utilizing these biofeedback methods, patients can effectively work towards improving their control over pelvic floor muscles and urethral sphincter function.

1. Indications

The biofeedback training procedure is indicated for a variety of conditions that affect the control of the anorectal and urethral sphincters. These indications include:

Urinary Retention - A condition where the patient is unable to completely empty the bladder, leading to discomfort and potential complications.
Urinary Incontinence - The involuntary loss of urine, which can significantly impact a patient's quality of life.
Fecal Incontinence - The inability to control bowel movements, resulting in unintentional leakage of stool.
Constipation - A common digestive issue characterized by infrequent or difficult bowel movements, which may benefit from improved muscle coordination.

2. Procedure

The biofeedback training procedure involves several key steps to ensure effective treatment and patient engagement. These steps include:

Step 1: Patient Preparation - The patient is prepared for the procedure by explaining the process and its benefits. This includes discussing the use of biofeedback devices and what to expect during the training sessions.
Step 2: Device Setup - A specialized manometer probe, equipped with multiple microsensors and a balloon or a water-perfused probe, is inserted into the rectum. This setup is crucial for measuring muscle activity and providing feedback.
Step 3: Monitoring Muscle Activity - As the patient engages in various exercises, the biofeedback device records muscle activity through EMG and displays this information visually or audibly. This feedback helps the patient understand their muscle function.
Step 4: Neuromuscular Conditioning - The patient practices neuromuscular conditioning techniques aimed at improving coordination of the anorectal muscles. This may involve exercises to tense and relax the pelvic muscles.
Step 5: Feedback and Adjustment - Throughout the training, the patient receives real-time feedback on their muscle activity, allowing them to adjust their techniques and improve their control over the pelvic floor and sphincter muscles.

3. Post-Procedure

After the biofeedback training session, patients are typically advised on post-procedure care and follow-up practices. This may include recommendations for continued exercises at home to reinforce the skills learned during the session. Patients are encouraged to maintain a regular schedule of practice to enhance muscle coordination and control. Additionally, follow-up appointments may be scheduled to monitor progress and make any necessary adjustments to the training regimen. It is important for patients to report any difficulties or concerns experienced during their training to ensure optimal outcomes.

Short Descr	BIOFEEDBACK PERI/URO/RECTAL
Medium Descr	BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG
Long Descr	Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	M5D - Specialist - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	213 - Physical therapy exercises, manipulation, and other procedures