Wiki Percutaneous Electrical Nerve Stimulation

[mwagone1]

Novitas, the Medicare MAC for PA has an LCD (L32710) listing PENS as an example of G0283. I've found many BCBS/Aetna and other payor documents stating they recognize PENS as 64999. I work for a payor that follows Medicare guidelines. Does anyone know what is the most appropriate code for Percutaneous Electrical Nerve Stimulation (not to be confused with code 64565 which is a surgical procedure where the electrodes are implanted permanently) in which the peripheral nerves are stimulated by a needle electrode inserted through the skin that is performed in a physicians office? Any help would be appreciated! Thank you

 

[mhstrauss]

I'm not familiar with PENS, but we use G0283 for TENS done by our PT department.

I'm also in Novitas, but in Louisiana, so I imagine our LCD's are similar.

The commercial equivalent of G0283 is 97014, which isn't covered by Medicare (this is for unattended stim). The attended session equivalent, for both Medicare and commercial payers, is 97032. Looking at the LCD, for 97032, is states to refer to same guidelines as G0283. With that in mind, I believe it can be assumed that PENS would also fall under 97032/97014. SO I guess the question is, are the sessions in the physician's office attended or unattended? I'm really not sure if I'm correct here, and I hope someone with more experience with this will chime in, just trying to think it through. Here are the 2 sites I was reading to get to this conclusion:

https://www.supercoder.com/coding-n...n-and-avoid-triggering-an-audit-40814-article

https://www.cms.gov/medicare-covera...hield+of+Georgia+(00101)&bc=gAAAABAAAAAAAA==&


I hope this helps some, and doesn't just cause more confusion!

 

[prayercoder]

Look at procedure codes 64553, 64561, 64555, 64565, 64566. They are all percutaneous electrical nerve stimulation codes. Each refers to a different area of the body. Hope this helps. I'm certainly not an expert.