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Improving Bladder Control

Clinical Basis

Urinary incontinence, or “overactive bladder,” is a common and often challenging problem for seniors. If left untreated, urinary incontinence increases the likelihood of hospital and nursing home admission.1

Clinical Guidelines

Urinary incontinence is an embarrassing problem that seniors may not bring to your attention during the office visit. Therefore, it is important to ask about it during the annual evaluation.

  • If patients have caregivers, be sure to also ask the caregivers about incontinence as the patients may not reveal that they are having a problem.
  • If a drug is suspected as the cause, it should be replaced or discontinued if possible.
  • Encourage nursing staff and medical assistants to ask patients about any incidents of urinary incontinence in the past six months. Patients are often too embarrassed to initiate the discussion.
  • Educate patients about noninvasive behavioral interventions for incontinence; when necessary, refer for appropriate treatment.
  • Make educational materials easily available so patients can use them as discussion starters for more sensitive topics (contact SCAN if you need resources).
  • Give patients after-visit summary and/or educational materials to reinforce that urinary incontinence was addressed during the visit. 

Drugs obtained over the counter also can be contributing factors. Diuretics increase urine production and may lead to worsening urge urinary incontinence and stress urinary incontinence as bladder filling and volume increase. Reversible etiologies are found in one-third of elderly ambulatory patients and contribute to half of the urinary incontinence among hospitalized elderly patients.2

 

Coding and Documentation Guidance

  • Document the assessment for urinary incontinence.
  • If a urinary incontinence plan of care is implemented and documented, submit CPT II code 0509F.

Urinary Incontinence: Additional Notes

Consider five types of urinary incontinence:

  • Stress: Leakage on effort, exertion, sneezing or coughing
  • Urge: Sudden, intense urge to urinate followed by an involuntary loss of urine caused by abnormal bladder contraction
  • Mixed: Leakage associated with urgency and also with exertion, effort, sneezing or coughing (stress and urge incontinence together)
  • Overflow: Leakage of urine from an over distended bladder
  • Overactive bladder: One or more of the following symptoms:
  • Urgency with or without urge incontinence
  • Urinary frequency
  • Nocturia in the absence of infection or other proven pathology 

Identifying the Common Etiologies of Reversible Urinary Incontinence Using “DIAPPERS”

Reversible urinary incontinence typically has been present for less than six weeks and had a sudden onset. The classic mnemonic DIAPPERS is applicable for identifying the common etiologies of reversible urinary incontinence:

Delirium
Infection (urinary tract)
Atrophic urethritis and vaginitis
Pharmaceuticals
Psychological disorders
Excessive urine output
Restricted mobility
Stool impaction3

 

1For an overview of this problem, see https://www.aafp.org/cme/cme-topic/all/overactive-bladder.html : 2016 FP Comprehensive, Urogynecologic Conditions, March 2015.

215.Imam KA. The role of the primary care physician in the management of bladder dysfunction. Rev Urol. 2004;6(Suppl 1):S38-S44

3Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician. 2013;87(8):543-550 26 Care for Older Adults

 

CPT II Codes

0509F - Urinary incontinence plan of care documented 

 

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