Skip navigation
9

Linda Collins Blogger

Ten things to remember about TENS Device

Posted by Linda Collins | August 28, 2012

DME MAC Jurisdiction D recently completed a widespread pre-payment review of transcutaneous electrical nerve stimulators (“TENS”) devices, 2 lead (HCPCS code E0720). The results showed an overall error rate of 95%. In other words, 95% of the claims submitted lacked necessary elements for payment.

The key reasons for denial included missing medical documentation that indicated need for a TENS/other modalities tried and an invalid CMN.

What do you need to know in order to avoid TENS claims errors?

  1. The physician ordering the TENS unit must be the attending physician or a consulting physician for the disease or condition resulting in the need for the TENS unit.
  2. If a TENS with 4 leads is used, the medical record must document why 2 leads are insufficient to meet the patient's needs.
  3. A TENS is covered for the treatment of patients with chronic, intractable pain or acute post-operative pain.
  4. For chronic pain, the medical 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 medical record must document what treatment modalities have been used.
  5. When used for the treatment of chronic, intractable pain, the TENS unit must be used by the patient on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will be paid as a rental.
  6. The physician's records must document a reevaluation of the patient at the end of the trial period, must indicate how often the patient used the TENS unit, the typical duration of use each time, and the results.
  7. The patient's medical records include the physician's office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available upon request.
  8. An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request.
  9. For a purchased TENS unit, a Certificate of Medical Necessity (CMN), which has been completed, signed and dated by the treating physician, must be kept on file by the supplier and made available upon request. The initial claim must include an electronic copy of the CMN. A CMN is not needed for a TENS rental.
  10. A TENS supply allowance (A4595) includes electrodes (any type), conductive paste or gel (if needed, depending on the type of electrode), tape or other adhesive (if needed, depending on the type of electrode), adhesive remover, skin preparation materials, batteries (9 volt or AA, single use or rechargeable), and a battery charger (if rechargeable batteries are used). Codes A4556 (Electrodes, [e.g., apnea monitor], per pair), A4558 (Conductive paste or gel), and A4630 (Replacement batteries, medically necessary TENS owned by patient) are not valid for claim submission to the DMERC. A4595 should be used instead.

For more information consult Transcutaneous Electrical Nerve Stimulators (TENS) Local Coverage Determination (LCD) and Policy Article at medicare-coverage-database.

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com