Knowing what is reasonable and necessary can help you bill and code better for this therapy

By Marty Kotlar, DC, CHCC, CBCS

Q: I just started supplying my patients with T.E.N.S. machines. What is the best way to bill and code for this therapy?

A: Let’s begin with a little background on T.E.N.S. therapy. Transcutaneous Electrical Nerve Stimulation therapy, more commonly referred to as T.E.N.S. therapy, uses electrical stimulation to diminish pain.

The electrodes are attached to the surface of the patient’s skin over the peripheral nerve to be stimulated. The T.E.N.S. unit works by decreasing the patient’s perception of pain by inhibiting the transmission of afferent pain nerve impulses and/or by stimulating the release of endorphins.

During the procedure, low-voltage electrical current is delivered through electrodes placed on the skin near the source of pain. T.E.N.S. therapy consists of a small, battery-operated device that can diminish pain by stimulating nerve fibers through the skin.

The electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that “scramble” normal pain signals, offering short-term pain relief. While effective in the short-term, long-term effectiveness of T.E.N.S. remains questionable.

Reasonable and necessary

T.E.N.S. must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function. T.E.N.S. is typically covered for the treatment of patients with chronic, intractable pain or acute post-operative pain.

When a T.E.N.S. unit is used for acute post-operative pain, the medical necessity is usually limited to 30 days from the day of surgery. Payment for more than one month is determined by individual consideration based upon supportive documentation. Payment for the first two months is typically made as a rental.

A T.E.N.S. unit may be denied as not medically necessary for acute pain (less than three months duration) other than post-operative pain. For chronic pain, the patient record must document the location of the pain, the duration of time the patient has had the pain, and the presumed etiology of the pain. The pain must have been present for at least three months.

Other appropriate treatment modalities must have been tried and failed, and the patient record must document what treatment modalities have been used. The presumed etiology of the pain must be a type accepted as responding to T.E.N.S. therapy.

A four-lead T.E.N.S. unit may be used with either two leads or four leads, depending on the characteristics of the patient’s pain. If four leads are ordered, the patient record must document why two leads are insufficient.

If two T.E.N.S. leads are medically necessary, then a maximum of one unit of a T.E.N.S. supply allowance (HCPCS Code A4595) would be considered medically necessary per month; if four T.E.N.S. leads are necessary, a maximum of two units per month would be considered medically necessary.

If the use of the T.E.N.S. unit is less than daily, medical necessity of the T.E.N.S. supply allowance is reduced proportionally.

A T.E.N.S. supply allowance (HCPCS code A4595) typically includes electrodes (any type), conductive paste or gel (if needed), tape or other adhesive (if needed), adhesive remover, skin preparation materials, batteries, and a battery charger (if rechargeable batteries are used). Replacement of lead wires more often than every 12 months is rarely medically necessary.

Make sure to contact all of the carriers you bill prior to submitting claims relating to T.E.N.S. therapy and find out their policy for this service.

Marty Kotlar, DC, CHCC, CBCS is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, drkotlar@targetcoding.com, or through www.TargetCoding.com.

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T.E.N.S. HCPCS codes, modifiers, and supplies

A4595: Electrical stimulator supplies, two leads, per month.

A4630: Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient

E0720: Transcutaneous electrical nerve stimulation (T.E.N.S.) device, two lead, localized stimulation

E0730: Transcutaneous electrical nerve stimulation (T.E.N.S.) device, four or more leads, for multiple nerve stimulation

RR Modifier: Rental

NU Modifier: New