Part B Insider (Multispecialty) Coding Alert

When neurologists use a form-fitting garment that delivers NMES electricity directly to the patient, report this service with  E0731 (Form-fitting conductive garment for delivery of TENS or NMES [with conductive fibers separated from the patient's skin by layers of fabric]). Because the descriptor for E0731 includes the word "TENS," some physicians and coders may believe that TENS and NMES are synonymous. Rather, TENS refers to transcutaneous electrical neurostimulators, which the physician may use to anesthetize nerves to control or block pain. The appropriate code for TENS is 64550 (Application of surface [transcutaneous] neurostimulator).
 
"TENS coding is subject to even further confusion because most carriers' LMRPs advise billing 97032 one or two times when training the patient on how to use TENS at home," says Melissa Humphrey, coding and billing coordinator at Warren Rehabilitation in Orlando, Fla. "Remember that 97032 is only used when training a patient on TENS." Bill actual application of TENS using 64550, she advises.
 
According to the December 1998 CPT Assistant , the 15-minute time frames referenced in the supervised modality code descriptors (such as 97032) "describe the total time, i.e., preservice, intraservice, and post-service time, spent in performing the modality." Therefore, if the therapist examined a patient before performing the electrical stimulation to determine whether his condition changed since his last visit, the time would be counted as "preservice" minutes and could be included in the total time spent with the patient.
 
Some neurology practices  skim the descriptors listed under TENS in CPT and see "neuromuscular" listed, "and they'll accidentally choose 64565 for NMES," Humphrey says. "But 64565 is for implantation of electrodes, whereas NMES is a therapy modality."