For Referring Physicians
The majority of our patients are referred by either their family doctor or gynecologist. We recognize that every referring doctor has different expectations or preferences. We ask that you specify what type of consultation you are requesting at the time of the initial consultation and provide us with a corresponding address so that we may get back to you with our recommendations. We would appreciate it if HMO patients are given a formal request for consultation (e.g. 99244) with the appropriate diagnosis (788.30 for urinary incontinence, 618.2 for pelvic organ prolapse, etc.). In all cases, we inform your patient clearly of the consultative nature of the referral, and will direct her back to you after completion of our services. We will not refer a patient to another physician without your input.
Evaluation & Management
If you request Evaluation and Management, we will see your patient promptly and perform a comprehensive evaluation of your patient’s symptoms. This assessment will include a physical examination, urine analysis, and possibly a determination of a post void residual urine. If indicated, urodynamic testing will be scheduled at a second visit. We will forward you a letter summarizing our findings and outlining initial management. If your patient requires reconstructive surgery, we will notify you of the date and location for this procedure. We will request medical clearance from your office when deemed appropriate and would prefer that this be done at least one week in advance of surgery. Postoperatively, we will correspond with you regarding your patient’s progress.
If you request Evaluation only, we will see your patient promptly for a comprehensive evaluation for incontinence, pelvic floor defects, or a second opinion regarding her gynecologic problem. If indicated, a separate urodynamic appointment will be scheduled. We will then be in touch with you regarding our recommendations for further evaluation or to discuss treatment options.
Urodynamic Evaluation – We are proud to offer state-of-the-art, multichannel urodynamic testing for the evaluation of urinary incontinence and voiding dysfunction in all of our office locations. This testing may include the following:
- Complex Uroflowmetry
- Complex multi-channel cystometric studies
- Urethral pressure profilometry
- Leak point pressure studies
- Voiding pressure studies
- Urethral EMG studies (when appropriate)
- Office cystoscopy (when appropriate)
Please note that our office policy requires that we first see the patient in consultation to determine the nature of the problem and to confirm that urodynamic testing is appropriate. Typically, examination of a urine specimen by culture, and a three day voiding diary will be performed prior to the testing.
Biofeedback & Electrical Stimulation Therapy
We are proud to offer one of the most comprehensive pelvic floor rehabilitation services directly in our office. This service is conducted by a physical therapist with extensive clinical experience in the evaluation and management of pelvic floor disorders, such as urinary incontinence, postpartum fecal incontinence and pelvic floor tension myalgia. These services are provided under the supervision of Marc Toglia, MD, and the appropriate referrals should be made out to him. This allows us to provide the most comprehensive services, without the typical restrictions that may be imposed by many third party insurers. In all cases, the patient must be first seen in consultation to determine the nature of the disorder and the appropriateness of biofeedback. Oftentimes, insurers will require a self-directed pelvic floor exercise program be completed before approving coverage for Biofeedback.