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Primary Care and TENS Treatments in an Article 28 Clinic

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    Default Primary Care and TENS Treatments in an Article 28 Clinic
    Medical Coding Books
    I work for an Article 28 Clinic. We have many services available to our patients, in-house. Our primary care clinician wants to be able to send patients over to the PT department for a TENS treatment to evaluate it's effectiveness. If it was effective, then have them come back or our PT department to have the TENS programmed and for patient instruction if it was beneficial and they buy their own. All documentation will go on it's own progress note in the primary care chart.

    1. Can I bill a 99406 for when the patient comes back with their own TENS to have it programmed, and bill it under the primary care doctor's provider number if the service was performed by the Physical therapist (the doctor will be on site when the services are performed)

    2. When they go over to the PT department, they are not going to have a complete PT evaluation, they will just go over with a written order from the primary care doctor for the TENS therapy. Can they go over on the same day as the office visit, get the TENS treatment and have it billed on the same billing sheet as their primary care E/M service under the primary care doctor's provider number?

    3. For the TENS treatment on the agency's machine, would we bill a 97014?

    4. Assuming we can do this service on the same bill as the primary care visit, would I append the modifier 25 to the E/M code?

    5. Does the Stark Law not apply because we are an article 28 clinic and we are billing incident to the primary care services?

    6. Would these services be excluded from Medicare coverage because they are incident to the primary care services, and therefore be exempt from ABN requirements for Medicare patients?
    Last edited by heatherwinters; 06-04-2008 at 07:09 AM.
    Heather Winters, CPC, CFPC

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