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The ABCs of coding-for electrical stimulation

Rehab Regs, July 9, 2003

The ABCs of coding-for electrical stimulation

Are you confused about how to code for electrical stimulation (e-stim) that you apply to patients? If so, it's understandable-thanks to CMS' recent introduction of codes this spring.

First off, it's important to understand the definition of e-stim. Most commonly, outpatient rehab providers may use either of two types of e-stim-unattended or attended-says Dick Hillyer, PT, MBA, MSM, consultant and owner of Hillyer Associates in Cape Coral, FL.

For an unattended session of e-stim, therapists apply electrode pads to body parts, set the appropriate parameters on a machine that feeds the electrodes, ensures that the machine performs correctly, and then attends to other tasks, Hillyer says.

In an attended session, the therapist stays with the patient after attaching the electrodes and remains involved with the treatment throughout the session.

"The clearest example of this is the use of electrical stimulation to specific muscles, using a pencil-sized probe with a telegraph key-type switch, to find a specific point and then stimulate the muscle motor point," Hillyer says.

"Similar probes are used to apply current with different parameters to known acupuncture points to bring about the desired effects."
However, many within the industry became confused after CMS released new coverage and coding information in the form of a program memorandum (PM) released in late 2002, as well as the 2003 Medicare Physician Fee Schedule.

Traditionally, therapists used CPT code 97014 for unattended e-stim. This code was not time-based. They used CPT code 97032 to reflect attended e-stim, with treatment measured in 15-minute increments, Hillyer says.

For clarification of the new rules, therapists should check out two sources-PM AB-02-161, which discusses coverage and billing requirements for e-stim for wound treatment, and the Medicare Physician Fee Schedule, as it appeared in the February 10 Federal Register, says David Ross, CPA, director of reimbursement and internal auditing for Kessler Rehabilitation Corp., in West Orange, NJ.

In PM AB-02-161, CMS notes that since April 1, Medicare only covers e-stim for the treatment of wounds for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers.

Medicare will not cover all other uses of e-stim for wound treatment. In both the PM and the Federal Register, CMS released the following coding information:

97014-Unattended e-stim, is not covered by Medicare.

97032-Application of a modality to one or more areas; e-stim (manual), each 15 minutes. CMS notes this code should not be reported for wound care of any sort, as wound care does not require constant attendance.

G0281-E-stim (unattended), to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers, not demonstrating measurable signs of healing after 30 days of conventional care-as part of a therapy plan of care.

G0282-E-stim (unattended) to one or more areas, for wound care other than described in G0281. CMS notes that this code is "not paid," due to the coverage decision listed above.

G0283-E-stim (unattended) to one or more areas for indications other than wound care, as part of a therapy plan of care.

Editor's note: Go to www.rehabregs.com/ppsrc/#Therapy to read AB-02-161. Go to www.rehabregs.com/ppsrc/#Medicare to read the 2003 Physician Fee Schedule.