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Transcutaneous Electrical Nerve Stimulation In The Treatment Of Overactive Bladder

SNOMED CT to ICD-10-CM Mapping Demo

In a randomized, double-blind, placebo-controlled study, Borch and associates evaluated the immediate effect on natural fill urodynamic parameters and bladder function during TENS in children with OAB and daytime UI . A total of 24 children with severe OAB and DUI underwent 48-hour natural fill urodynamics. After 24hours of baseline investigation, the children were randomized to either active continuous TENS or placebo TENS over the sacral S2-S3 outflow. The urodynamic recordings were analyzed manually for 3 different bladder contraction patterns resulting in a void. The number of bladder contractions not leading to a void was also calculated. Maximum voided volume and average voided volume were identified for both the baseline and the intervention day. It was found that TENS had no immediate objective effect on bladder capacity. The difference in MVV/EBC in the active TENS group=0.03±0.23 versus placebo TENS group=-0.01±0.10 . Furthermore, there was no significant difference in the proportion of different bladder contraction types between the 2 groups TENS did not significantly influence the number of bladder contractions not leading to a void. Results were presented as mean±SD. The authors concluded that there was no immediate objective effect of TENS on bladder activity assessed by natural fill urodynamics in children with OAB and DUI.

Pelvic Floor Electrical Stimulation

  • Campbell SE, et al. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev, 2012 1:CD001843.
  • Carlson K, Nitti V. Prevention and management of incontinence following radical prostatectomy. Urol Clin North Am. 2001 28.
  • Grise P, Thurman S. Urinary incontinence following treatment of localized prostate cancer. Cancer Control. 2001 8:532-539.
  • Richardson DA, Miller KL, Siegel SW, et al. Pelvic floor electrical stimulation: A comparison of daily and every-other-day therapy for genuine stress incontinence. Urology. 1996 48:110-118.
  • Sand PK, Richardson DA, Staskin DR, et al. Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: A multicenter, placebo-controlled trial. Am J Obstet Gynecol. 1995 173:72-79.
  • Siegel SW, Richardson DA, Miller KL, et al. Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women. Urology. 1997 50:934-940.
  • Wille S, et al. Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: Results of a prospective randomized trial. Urololgy. 2003 170:490-493.
  • Yamanishi T et al. Randomized, placebo controlled study of electrical stimulation with pelvic floor muscle training for severe urinary incontinence after radical prostatectomy. J Urol. 2010 184:2007-2012.
  • Zhu VP et al. Pelvic floor electrical stimulation for postprostatectomy urinary incontinence: A meta-analysis. Urology. 2012 79.
  • Gene Testing For Stress Urinary Incontinence

    An UpToDate review on Evaluation of women with urinary incontinence states that The risk of urinary incontinence, particularly urgency incontinence, may be higher in patients with a family history. One study found that the risk of incontinence was increased for both daughters and sisters of women with incontinence. Twin studies attribute a 35 to 55 % genetic contribution to urgency incontinence/overactive bladder but only 1.5 % for stress incontinence.

    Furthermore, an UpToDate review on Urinary incontinence in men does not mention genetic testing as a management option.

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    The Adjustable Transobturator Male System For The Treatment Of Stress Urinary Incontinence

    The authors stated that the main drawbacks of this systematic review and meta-analysis lied in the scant level of evidence provided by the design and nature of the non-controlled, and mainly retrospective, studies available, and in their relatively short follow-up. The variable nature and severity of SUI and the different proportion of patients receiving radiation likely explained the high heterogeneity observed. Combining the results of individual studies increased the total number of participants and more participants imply more statistical power. However, combining studies with differences among participants could also reduce statistical power and make real effects more difficult to identify.

    The authors stated that the main drawbacks of this meta-analysis included the short-term follow-up , especially in the ATOMS-arm, and in the very high heterogeneity observed between studies probably reflecting a variable severity of sphincteric damage included and the absence of RCTs. Furthermore, the criteria to report complications appeared variable between the studies analyzed. The drawbacks highlighted were in consonance with the publication bias identified according to Eggers linear regression. It should also be noted that the ATOMS studies had shorter follow-up than the ProACT studies .

    Furthermore, an UpToDate review on Urinary incontinence in men does not mention Adjustable Transobturator Male System as a therapeutic option.

    Periurethral Injections Of Bulking Agents

    Malignant Genital Or Urinary Neoplasm
  • Altman D, Ghilotti F, Bellocco R, et al. Transurethral polyacrylamide hydrogel injection therapy in women not eligible for midurethral sling surgery. Female Pelvic Med Reconstr Surg. 2017 23:318-323.
  • Angioli R, Muzii L, Zullo MA, et al. Use of bulking agents in urinary incontinece. Minerva Ginecol. 2008 60:543-550.
  • Dmochowski RR, Appell RA. Injectable agents in the treatment of stress urinary incontinence in women: Where are we now? Urology. 2000 56:32-40.
  • Eckford SD, Abrams P. Para-urethral collagen implantation for female stress incontinence. Br J Urol. 1991 68:586-589.
  • Food and Drug Administration. Bulkamid Urethral Bulking System – P170023. FDA: Silver Spring, MD. Available at: Accessed October 1, 2020.
  • Ghoniem G, Corcos J, Comiter C, et al. Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: Results of a multicenter, randomized, controlled, single-blind study. J Urol. 2009 181:204-210.
  • Herschorn S, Steele DJ, Radomski SB. Followup of intraurethral collagen for female stress urinary incontinence. J Urol. 1996 156:1305-1309.
  • Hussain SM, Bray R. Urethral bulking agents for female stress urinary incontinence. Neurourol Urodyn. 2019 38:887-892.
  • Kasi AD, Pergialiotis V, Perrea DN, et al. Polyacrylamide hydrogel for stress urinary incontinence in women: A systematic review of the literature. Int Urogynecol J. 2016 27:367-375.
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    Other Specified Urinary Incontinence

      20162017201820192020202120222023Non-Billable/Non-Specific Code
    • N39.4 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
    • The 2023 edition of ICD-10-CM N39.4 became effective on October 1, 2022.
    • This is the American ICD-10-CM version of N39.4 – other international versions of ICD-10 N39.4 may differ.
    • any associated overactive bladder (
        20162017201820192020202120222023Billable/Specific Code

      Applicable To

    Magnetic Stimulation For Women With Stress Urinary Incontinence

    In a meta-analysis of studies with short-term follow-up, Peng and colleagues examined the efficacy of magnetic stimulation in female patients with SUI by investigating peer-reviewed RCTs. PubMed, Embase, and Cochrane library were retrieved for any peer-reviewed original articles in English. Databases were searched up to July 2018. Included studies examined effects of MS on SUI. The data were analyzed by review manager 5.3 software . A total of 4 studies involving 232 patients were identified and included in present meta-analysis. Compared with the sham stimulation, the MS group had statistically significantly fewer leaks/3 days , less urine loss on pad test , higher QoL scores , and lower ICIQ scores . MS presented higher cure or improvement rate, with a statistically significant improvement in UDI and IIQ-SF scores compared to sham stimulation. No MS-related AEs were reported in study. The authors concluded that MS led to an improvement in SUI without any reported safety concerns and an improvement in patient QoL however, the long-term outcome of this technique remains unclear and is the subject of ongoing research.

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    Magnetically Controlled Endourethral Artificial Urinary Sphincter

    Mazzocchi and colleagues stated that UI is a widespread dysfunction that affects more than 300 million people worldwide. At present, no technological solutions are able to restore continence in a minimally invasive and effective way. These researchers described the design, fabrication, and testing of a novel artificial endourethral urinary sphincter that attempts to fully restore continence. The device can be inserted/retracted in a minimally invasive fashion without hospital admission, does not alter the body scheme and can be applied to both women and men. The device core is a uni-directional polymeric valve and a magnetically activated system, which is able to modulate its opening pressure. Bench tests and ex-vivo tests on a human cadaver demonstrated that the device was able to fully restore continence and allowed urination when desired. The authors concluded that the proposed system showed a high potential as a technological solution that may restore a normal daily life in patients affected by UI. These preliminary findings need to be validated by well-designed studies.

    Other Urinary Incontinence Interventions

    Pelvic Muscle Trainers

    Note: Aetna does not cover the Athena pelvic muscle trainer, Gyneflex, Kegelmaster, Leva Pelvic Floor Trainer, or similar devices for the treatment of UI because these devices are considered exercise machines, and they do not meet Aetna’s definition of covered durable medical equipment . Most Aetna plans exclude coverage of exercise devices. Please check benefit plan descriptions for details. In addition, such exercise devices do not meet Aetna’s definition of covered DME because they are not primarily medical in nature and/or are normally of use to persons who do not have an illness or injury.

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    What Does Excludes Mean In A Note

    An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. A type 2 Excludes note represents ‘Not included here’.

    Moxibustion For The Treatment Of Post

    Li and colleagues noted that UI is a frequently identified complication among stroke survivors. Moxibustion is commonly used to treat post-stroke UI in Asian countries. In a systematic review and meta-analysis, these researchers examined the evidence of using moxibustion for post-stroke UI management. A total of 12 databases were searched to identify RCTs using moxibustion to improve post-stroke UI management 4 Chinese journals were also manually screened for potentially eligible articles. A total of 10 studies with 719 subjects and 1 completed trial without published results were included. Compared with “routine methods of treatment and/or care”, the meta-analyses revealed that moxibustion had superior effects in improving UI symptoms and alleviating the severity of UI. The authors concluded that this systematic review identified preliminary research evidence that moxibustion may be effective in managing the symptoms of post-stroke UI these investigators stated that more rigorously designed, large-scale RCTs are needed to provide more robust evidence in this area.

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    Test Stimulation Of The Interstim

    The InterStim product labeling states that, in clinical studies, subjects underwent anywhere from 1 to 6 test stimulation procedures before implantation of InterStim.

    The Medtronic InterStim test stimulation lead kit manual stated that Of the 260 patients who qualified for implantation, 169 had a successful result during their first test stimulation procedure. Of the remaining 91 patients, 56 obtained a successful result during a second test stimulation, and 35 obtained a successful result during three or more test stimulations. Reasons for repeat test stimulation procedures included inadequate responses to test stimulation or technical problems . The safety and effectiveness of this therapy has not been established for pediatric use , patients with neurological disease origins, such as multiple sclerosis or diabetes, and bilateral stimulation.

    What Is The Difference Between Urge Incontinence And Stress Incontinence

    Icd 10 Cm Code For Visual Field Defect. Right Eye.

    There are several types of incontinence: Stress incontinence is leakage of urine caused by coughing, sneezing, or other movements that put pressure on the bladder urge incontinence is the loss of urine after feeling a sudden need to urinate. Many people have symptoms of both stress incontinence and urge incontinence.Aug 27, 2021

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    Bariatric Surgery For The Treatment Of Urinary Incontinence In Obese Women

    In a meta-analysis, Zhang and colleagues examined the effectiveness of bariatric surgery in obese women with UI. Searches of PubMed, the Cochrane Library, and Embase databases were performed using “weight loss surgery/bariatric surgery/gastric bypass surgery” and “incontinentia urinae/uracratia/urinary incontinence/uroclepsia” in the title/abstract before January 2018. Then, meta-analysis was analyzed by Review Manager 5.3 . The SMD and OR were used to describe results of continuous variables and dichotomous variables, respectively. Pooled data showed that bariatric surgery reduced the incidence of UI in obese women at the follow-up of 6 months and 12 months and significantly reduced the BMI at 6 months and 12 months . In addition, bariatric surgery could also significantly increase the QOL and improve the function of pelvic floor disorders based on QOL questionnaires and Pelvic Floor Distress Inventory 20, respectively. The authors concluded that this meta-analysis demonstrated that bariatric surgery is an effective choice for obese women with UI however, more RCTs are needed to confirm these findings.

    Furthermore, UpToDate reviews on Treatment of urinary incontinence in women and Treatment of urgency incontinence/overactive bladder in women do not mention bariatric surgery as a therapeutic option.

    What Does Type 1 Excludes Note Mean

    It means “not coded here”. A type 1 excludes note indicates that the code excluded should never be used at the same time as R32. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. inability to control the flow …

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    What Is A Incontinence Diagnosis

    How is urinary incontinence diagnosed? To diagnose the cause of your urinary incontinence, your doctor will do a physical exam and ask about your past health. Your doctor will ask about what and how much you drink. You will also be asked how much and how often you urinate and leak urine.

    What is the ICD 10 code for female incontinence?

    N39.32021 ICD-10-CM Diagnosis Code N39. 3: Stress incontinence

    What is urinary urge incontinence?

    urge incontinence when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards. overflow incontinence when youre unable to fully empty your bladder, which causes frequent leaking.

    What is mixed incontinence?

    Activities such as coughing, sneezing, laughing, exercise, and even standing up can cause leakage in women with stress incontinence. Its common for women to experience symptoms of both urge and stress incontinence. This condition is called mixed incontinence.

    Who Family Of International Classifications

    The World Health Organization maintains several internationally endorsed classifications designed to facilitate the comparison of health related data within and across populations and over time as well as the compilation of nationally consistent data. This “Family of International Classifications” include three main classifications on basic parameters of health prepared by the organization and approved by the World Health Assembly for international use, as well as a number of derived and related classifications providing additional details. Some of these international standards have been revised and adapted by various countries for national use.

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    How Often Does Overactive Bladder Cause Urinary Incontinence

    While about 40% to 70% of urinary incontinence is due to overactive bladder, it is not life-threatening. Most people with the condition have problems for years. A Code Also note indicates that two or more codes may be required to fully describe a condition, but the order of codes is at the coders discretion.

    Is there such a thing as bladder incontinence?

    If there is loss of bladder control then it is known as urge incontinence. More than 40% of people with overactive bladder have incontinence. While about 40% to 70% of urinary incontinence is due to overactive bladder, it is not life-threatening. Most people with the condition have problems for years.

    Percutaneous Tibial Nerve Stimulation

  • BlueCross BlueShield Association , Technology Evaluation Center . Percutaneous tibial nerve stimulation for the treatment of voiding dysfunction. TEC Assessment Program. Chicago, IL: BCBSA March 2011 25.
  • De Gennaro M, Capitanucci ML, Mastracci P, et al. Percutaneous tibial nerve neuromodulation is well tolerated in children and effective for treating refractory vesical dysfunction. J Urol. 2004 171:1911-1913.
  • Govier FE, Litwiller S, Nitti V, et al. Percutaneous afferent neuromodulation for the refractory overactive bladder: Results of a multicenter study. J Urol. 2001 165:1193-1198.
  • Hoebeke P, Renson C, Petillon L, et al. Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: A pilot study. J Urol. 2002 168:2605-2607 discussion 2607-2608.
  • Krivoborodov GG, Mazo EB, Shvarts PG. Afferent stimulation of the tibial nerve in patients with hyperactive bladder. Urologiia. 2002 :36-39.
  • MacDiarmid SA, Peters KM, Shobeiri SA, et al. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol. 2010 183:234-240.
  • Peters KM, Carrico DJ, Wooldridge LS, et al. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013 189:2194-2201.
  • van Balken MR. Percutaneous tibial nerve stimulation: The Urgent PC device. Expert Rev Med Devices. 2007 4:693-698.
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    Extraurethral Retropubic Adjustable Compression Devices

  • Aboseif SR, Franke EI, Nash SD, et al. The adjustable continence therapy system for recurrent female stress urinary incontinence: 1-year results of the North America Clinical Study Group. J Urol. 2009 181:2187-2191.
  • Australian Safety and Efficacy Register of New Interventional Procedures – Surgical . ProACT Therapy for male stress urinary incontinence. Horizon Scanning Prioritizing Summary. Canberra, ACT ASERNIP-S for HealthPACT and MSAC September 2006.
  • Gilling PJ. New treatments for recurrent stress incontinence. J Urol. 2009 181:1992-1993.
  • Kocjancic E, Crivellaro S, Ranzoni S, et al. Adjustable continence therapy for severe intrinsic sphincter deficiency and recurrent female stress urinary incontinence: Long-term experience. J Urol. 2010 184:1017-1021.
  • National Institute for Health and Clinical Excellence . Insertion of extraurethral retropubic adjustable compression devices for stress urinary incontinence in women. Interventional Procedure Guidance 133. London, UK: NICE July 2005.
  • National Institute for Health and Clinical Excellence . Insertion of extraurethral retropubic adjustable compression devices for stress urinary incontinence in men. Interventional Procedure Consultation Document. London, UK: NICE March 2007.
  • Phe V, Nguyen K, Roupret M, et al. A systematic review of the treatment for female stress urinary incontinence by ACT® balloon placement . World J Urol. 2014 32:495-505.
  • Screening For Urinary Incontinence In Women

    Pelvic Floor Dysfunction Male Icd 10

    Despite the lack of studies determining the benefits and harms of UI screening, the Women’s Preventive Services Initiative recommended that doctors screen women of all ages, including adolescents, for UI yearly by using a questionnaire. The WPSI recommended referring women with UI for further evaluation if it affects their activities and QOL. These recommendations were based on indirect evidence that UI is common, treatment may be effective, and the harms of screening are unlikely to be serious. The recommendations might change if studies directly evaluating the benefits and harms of screening for UI become available. There are no data to support that the correct frequency of screening is yearly .

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