Eli's Rehab Report

The Health Care Financing Administration (HCFA) revised its 20-year-old policy regarding nonunion of long-bone fractures, and now allows electrical stimulation using invasive and/or noninvasive devices for long-bone fractures after three or more months have elapsed without healing. The new ruling took effect on April 1, 2000, replacing the policy that had been in place since 1980, which allowed electrical stimulation for long-bone fractures only after healing had ceased for six or more months.

In the ruling released in Medicare Coverage Policy, Review Issue Number CAG-00043, HCFA stated that experts from a workshop by the National Institute of Arthritis, Metabolism and Digestive Diseases and the American Academy of Orthopedic Surgeons concluded that non-invasive pulsing electromagnetic fields are both safe and effective in treating nonunion of long bones, failed fusion and congenital pseudoarthroses, and that this treatment should be used only in cases unresponsive to conventional treatment modalities. HCFAs publication of review issues defines long bones as the clavicle, humerus, radius, ulna, femur, tibia, fibula, metacarpal and metatarsal.

I sometimes see patients whose fractures havent healed with traditional treatments, such as casts, splints and even pins or screws, and they want to find an alternative to bone grafts or other invasive surgeries, says Paul Porter, MD, a practicing rehabilitation specialist in Los Angeles. Particularly for sports injuries or for injuries incurred by the elderly, the patients main concerns with surgery are things like extended recovery time or complications.

Nonunion can occur for several reasons, including poor casting, infection, and outside bone conditions such as osteoporosis (733.0-733.09). Patients probably will be glad to have the option of using electrical stimulation without having to wait six months before its allowable, Porter says.

HCFAs new policy, listed under section 35-48 of the Coverage Issues Manual, states, Nonunion of long-bone fractures, for both noninvasive and invasive devices, is considered to exist only when serial radiographs have confirmed that fracture healing has ceased for three or more months prior to starting treatment with the electrical osteogenic stimulator. Serial radiographs must include a minimum of two sets of radiographs, each including multiple views of the fracture site, separated by a minimum of 90 days.

Electrical stimulation to aid bone healing should be billed using CPT 20974 (electrical stimulation to aid bone healing; noninvasive [nonoperative]) or 20975 (electrical stimulation to aid bone healing; invasive [operative]).