How to Bill and Code for Tens Units and Electrodes
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Now, today's topic, TENS unit billing and coding. This is an amazing topic, because lot of people don't know that you can bill these to insurance carriers. They're paid by Medicare, they're paid by Medicaid, they're paid by general carriers. What I want to do first is kind of explain a little bit about the TENS units, a little bit about the placement and then I want to go to the billing and coding aspect of the TENS units and the electrodes.
So first of all, TENS units are designed to decrease pain and burning sensation. They increase circulation, and they come typically in a biphasic waveform of 80Hz with variable pulse width's. A lot of people ask, "well what's the appropriate TENS unit to use?" They'll see there's different types. There's Microcurrent, there's TENS, there's Interferential, there's Russian Stim, there's combination units.
"Which one would I use?" Well let me just explain to you the different types first of all. There's TENS that we're going to go through today; and TENS is for pain. Very, very simple. When the TENS unit is on, it's helping you decrease that pain. When it off, there's no other healing properties that are occurring. So TENS is used when you're in pain.
Interferential, which is another type of unit that we carry, is typically used for more of the healing process, it goes deeper into the tissue and also helps decrease pain by an increased circulation, so interferential is typically a little bit stronger than TENS which is just solely for pain.
Then we have Microcurrent. Microcurrent does help in the healing process of nerve tissue. We also have EMS. EMS is for reeducation of muscle. And then we have Russian Stim. Russian Stim is designed to help strengthen muscle. See, of all these different types of units that are found, in fact, I think we have over 100 different units on our website, we have the largest selection in the country. So which ones do you use and when? It depends really on what the patient presents themselves with and what you're trying to accomplish. As far as today's webinar though, from a billing perspective, typically the insurance carriers will only pay for TENS. And we're going to go through that. So if you have a combination unit which may be more beneficial for the patient, by using EMS or interferential, and you pay more for that unit, it doesn't mean you're going to get paid more by the insurance carrier.
So we're going to talk about what they do pay for, which is TENS. Now, the other aspect to TENS units are the electrode placement and a lot of practitioners say "well where will I place the electrodes?"and the best way I can kind of help you here is, let's pretend that our pain is right here. So this X marks the spot of the pain on the body where we're going to use the TENS unit. What happens is off the TENS unit there are two lead wires that come up just like that, and then they break into two wires, and typically they come in different colors, so you'll have a red and a black and a red and a black. So, what you want to do is, you want to crisscross the different color lead wires, and by the way that lead wire plugs directly into that electro just like that. So you want to crisscross the colors of the lead wires, so for instance you have a red lead wire coming here and a red lead wire coming here, so you're going to crisscross over that point of pain. Here you have a black lead wire and a black lead wire. You're going to crisscross red to red and then black to black. And it doesn't matter where this is on the body, it can be in a small aspect of the foot, for instance, or the hand or can be in a large area from the cervical region all the way down to the lumbar region. As long as you're crisscrossing those electrodes in those lead wires from black to black and red to red over the point of pain you'll get the maximum amount of relief.
So when do you use a TENS unit? Again there's no manual that says when to use the TENS unit, how often, and for what condition. So you or your practitioner has to decide. Typically they will be used for 15 min increments and you can go up to thirty minute increments, three to four times daily again they depend on the condition, and when the patient's experiencing pain is when you want to use the TENS unit. They can be used in the office, or home or even traveling for instance, that's the great part about these TENS units, they are so portable. And they really provide a substantial amount of relief and they give you the option as far as not having to use drugs or medication. So they're very beneficial towards the patient.
They can be used in a different amount of ways. Now, a lot a podiatrists will use these for diabetic nephropathy and there's been some studies done back in the eighties where patients would wear them for two to eight hours per day and it actually showed them that their condition started to get better by wearing TENS for long periods of time. Now, one thing that is important to notice, if you're going to get a system which we typically don't recommend without a timer, be very, very careful. So we have I think two TENS units in our site that don't have timers, that may be more cost effective, all the other ones have timers. So if you don't have a timer, you have to have your patient shut it off. So we typically recommend using a timer and typically 15 to 30 minutes, longer tough, if you're getting relief while you're feeling that pain.
So let's go into the billing aspect now. For billing a lot of people also say "What's the best unit to bill?" It doesn't matter the unit that you choose for billing as long as it's a TENS unit, because you are going to be billing under a TENS code.
There are a lot of different types units out there, and we do have a great section on our website, under the blog section, on the doctor side where they actually go into a product review of each TENS unit and different types of TENS units so you can choose what's best for you and for the patient. But if you're looking at basic types of units we typically recommend the TENS 3000 which may be the most popular unit, and then we have what's called the TENS AA.
The tense 3000 isn't analog, what that means is, you turn knobs as opposed to pushing buttons so it's not electronic. So it's maybe a lot more easy to use by people that are not computer literate. The TENS AA is a more high-powered TENS unit, but it is a digital unit, so a lot of practitioners feel like they're going to be making money from the insurance carrier, it's always nice to have a higher quality unit; and we do have units that are a lot more quality, a lot more powerful as well. The TENS 7000 may be the most powerful unit we have and then the line of Intensity units are fantastic at a very low cost as well as the CareTec units. Great units, very inexpensive, high quality, and typically come with the year warranty.
As far electrodes, they come in many different shapes and sizes. Electrics come circle, come square, rectangle, butterfly... It really depends on the area of the body you're looking for. The electrodes also come in different types as far as cloth or fabric. So cloth and fabric are used for more movable areas like the cervical region or hand or foot. But you may want to use a foam electrode on an area that's not real movable like the lower back. So that hopefully gives you some help determining which are best for you. Typically the 2x2 electrode is the most popular or the 11/2 x 11/2 for our podiatrists that work on a smaller area.
So the code that we're going to be using is the HCPCS code E0730 for TENS. And a lot of people say, "how much should I bill?", I would say the national average is about $495 for that TENS unit. As far as electrodes, here's two codes that you're going to use: for electrode we have the A4556 and the A4595. The A4556 is typically used for general carriers, and the A4595 is typically used for Medicare. And it ranges, a lot of practitioners will charge anywhere from $10 to $28 per package; it really depends on your area and the service behind it. What I do recommend though is, you want to add these HCPCS codes to your insurance verification form, so therefore, it's pre-verified on all your patients. So if the doctor or the practitioner decides to write a script for this, then you're all set, you don't have to go back and then verify the insurance. So we would add these DME codes to the insurance verification form in case that we need it for the patient. Like I said earlier, they are reimbursable by Medicare and most general insurance carriers.
Also, lead wires. The lead wire is A4558 and we recommend... a lot of times, these lead wires may not last the course of 3, 6 months or a year, based on the patient and the use of the system. So we would recommend giving the patient at least one extra package of lead wires, they only cost an additional $3 and it's a great little help to the patients so they don't have to go search for them if they do break or come back to you. So what we try to do is, package together, to give everything the patient would need: a TENS unit, all the electrodes, lead wires and then also batteries, we have batteries starting at $0.50, very portable, high quality batteries that you can't find cheaper anywhere else. So it's great to put that all together, provide it to the patient, maybe in a nice bag for them and they can go home especially with your information on that bag, we kind of call it a TENS kit, where they get everything they need, you're billing the carriers for what you're providing them and it's nice to offer them.
Now as far as general insurance. So let's start with general insurance and then we'll go into Medicare billing. General Insurance, the HCPCS code, like I said earlier, is E0730 and we're going to use a P modifier. Now this is important, some carriers you'll have just one digit on the modifier, some may have two, so if they asked for two, you may put a PP modifier. Okay? If they have one you'll just put a P, for purchase, and typically a $495 but again that's up to you, what you want to put as far as the purchase price of that TENS unit. Now sometimes if this particular carrier -general carrier- follows more Medicare you may be required to do the NU, for a new purchase, it really depends on the carrier and where you're located but typically it'll be a P for purchase on the HCPCS code and what you want to do or what I recommend is, split your claims for that day, so provide the carrier with whatever else you doing, your exam, your treatment and then split the claim and put your DME all in a separate claim. Therefore you'll have a better chance of being paid fairly for the DME that you're providing to the patient. So remember that, split your claim.
Also, your TENS unit will come with one package of electrodes, a battery, and lead wires. Now that one package of electrodes typically will last about one week, it's considered one billing unit and will come with for pads per package and with general carriers you can typically bill up to 12 packages of electrodes for a three month period of time, based on medical necessity. So they warrant that you can do three months at a time so the patient doesn't have to keep coming back for those electrodes. So what I would do is, bill out the TENS units, split your claim today when the patient comes to see you, wait one week and then bill out 12 packages, again based on medical necessity, at once which will be 12 weeks of your electrodes. They're reimbursable by most general insurance carriers like I said, it's a great revenue source for the practice, again an alternative for the patient. So that's general carriers, Now, you are required to fill out a medical necessity form, if you don't have one we can provide one for you, but it is needed -a medical necessity form- in your notes and you want to document why you're providing this unit; it typically doesn't matter with the carrier, if they have a prerequisite like three months of prior chronic pain or acute pain, that's more for Medicare but for general carriers, if they got it yesterday, you typically can provide them a unit today, again based on your exam and your findings.
This is something people forget, conductive garments. The HCPCS code is E0731, and along with the conductive garment you do need the electrode spray, so this is important, the skin spray to give a conductive appearance for the TENS unit. But they come in all different shapes and sizes, they come for the hand, the foot, we have for the knee, the elbow, and these garments are fantastic so you don't have to put electrodes on the body. They're very inexpensive, at $36 each, but they're also highly reimbursable. So I believe anywhere from $100 to $200 they're reimbursable from general carriers as well Medicare so if the patient has trouble with the electrodes, or maybe if it's a plantar fasciitis or a diabetic neuropathy, a larger scope area... these garments are very, very good. But please don't forget the skin prep, you need that to have the conductivity work properly.
So tens billing... On Medicare... Very, very different. We're going to use the same code, the E0730, but the first month and possibly depending on the quadrant you're in, it will be a second month rental period, and a rental period is just what it says, you're providing that TENS unit for rent to that patient. And you want to pre-verify of course. Now some general carriers may have a rental period as well, so you do want to put on your insurance verification even for general carriers, is there a rental period for that TENS unit, because you do want to know. So I recommend the code E0730, but now you're going to put an RR modifier to tell the insurance carrier that it's a rental and I'd say the national average, anywhere up to $275 for that rental. Medicare typically pays between $30 and $40 for that rental period. Now during that rental period you cannot bill for electrodes; we recommend giving them four packs for the rental period, again one pack equals about one week, so you're not going to bill for it but you want to provide them obviously electrodes to use during that period of time. On month two, you'll be able to start billing for the electrodes at $40 per month. A little disclaimer, always check your LCD's, very, very important because obviously you may be in a different quadrant than somebody else. But the main stipulation for Medicare is, you have to have, and document, prior chronic pain for the last three months. So you must document that that patient has had chronic pain for the last three months, if they have, you can administer that TENS unit. You also want to document whatever treatment that they had for those three months, whether it's aspirin or physical therapy, you want to put that in your documentation, your medical necessity form. You're also required to fill out all your CMS forms to go along with your DME disbursement... okay? And if you need help with getting a DME license, please go on our website and check out our webinars on DME and you can also contact us and we can have you contact someone that will help you get your DME license.
So that was month one rental, on month two we're going to bill this out as a new purchase, and you're going to bill it out as E0730 with an NU for new purchase and then a KX modifier, in fact the KX will go right here, so E0730NUKX. And that's going to stipulate your billing it out as a new purchase. Again most people bill out at $495 based on their area. Then, you can bill out your electrodes, the code you're going to use for Medicare is A4595, that allows you two packages per code, so you're going to bill this out twice for two units for that month, which is four packs per month, again always check your LCDs. Now, you'll typically look at about $40 per month for the electrodes, based on medical necessity, but very, very important, after the rental period, you do have to have the patient come back, you do have to do a reexamination on them, and then you have to document that they're getting better by using that TENS unit. If they're not getting better, then you cannot move past the rental period. So if they are getting better, then document they are, and then you can go ahead with your purchase. And that's basically how you would bill out Medicare, all your forms are needed and your exam forms are needed.
If you have any questions please, at any time, email us at firstname.lastname@example.org and please if you want some help, please ask us for our free electrotherapy coding and billing guide, but very, very important please tell me what type a practitioner you are, because we have different coding guides for different professions, so if you're a podiatrist or a chiropractor please let us know what type of profession you are and we'll get you the appropriate billing and coding guide. Also any types of questions you have at all times, please feel free to contact us and we'll be happy to help you. So again, this is a free coding guide, to kind of walk you through everything we're doing with this webinar and this will be as well recorded and you'll be able to go back and listen to it at any time.
I'd like to bring up his DME by the way, I know we're talking about TENS units, but this DME uses the same medical necessity form as the TENS unit and these are your pneumatic cervical collars. And typically they're billed out as HCPCS code E0855 or E0856 and it just depends on the unit that you're using. This is probably one of the most popular products that we have nationally on our website, and is Pneumatic Cervical collar, and we have the best price available on the country, they're very affordable and the best part is, they're highly reimbursable, so typically you can bill them out up to $495; I've seen them reimbursed all the way from $100 to $495. But again they're using the same medical necessity form, now if you don't have a medical necessity form, again please email us and we'll be happy to provide you a basic medical necessity form that you can use for this DME or others.
And also please be on the lookout for all of our other webinars on DME billing where we go through all the products if you have a DME license, you'll be able to bill, and a lot of products can be billed to general carriers as well.
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