Dynamic Chiropractic – February 26, 2007, Vol. 25, Issue 05

## Appropriate Billing for Electrical Stimulation

###### By Samuel A. Collins

Q: My doctor is performing electrical stimulation to the low back and the neck. Can I bill for two units of this service?

A: This question actually has multiple answers, depending on the type of electrical stimulation service that is being performed and the time spent performing the service.

Scenario 1: The patient is receiving unattended electrical stimulation to the neck and low back.

When unattended electrical stimulation is done, it is coded under 97014; as a supervised modality, it would only be billed once, regardless of the number of regions or the time spent. Therefore, to answer your initial question, if the electrical stimulation were unattended, those services would be billed for a single unit. The billing rule for all supervised modalities is that they are billed for only one unit, regardless of the time spent or number of regions treated on the same visit with the same service.

Scenario 2: The patient is receiving attended electrical stimulation to the neck and low back. When attended electrical stimulation is done, it is coded under 97032; as a constant attendance modality, it is billed according to the time spent performing the services. This service, as with all physical medicine timed codes, lasts 15 minutes. Therefore, it is not the number of regions treated that dictates the units to be billed, but the amount of time doing the service. According to the Centers for Medicare and Medicaid Services (CMS), a provider must spend at least eight minutes of the 15-minute unit to bill for that service.

For one unit, a minimum of eight minutes must be performed and can go as high as 22 minutes. For two units, it would be 23 minutes up to 37 minutes; and for three units, 38 to 52 minutes.

To answer the initial question using 97032, assumption one is that eight minutes were spent on each region, for a total of 16 minutes; therefore, we can bill only one unit. Assumption two is that 12 minutes were spent on each region (24 minutes total time), in which case the service can be billed for two units. The billing rule for all constant attendance modalities is that they are billed in units based on the time the service is applied, not the number of regions.

It is my experience that the most common electrical stimulation service is of the unattended variety. Consequently, most often, electrical stimulation is billed for a single unit. If you are using unattended electrical stimulation, it is important that the documentation clearly note the service is attended, with the specific time spent clearly written as part of the record.