modalities / therapies

When performed and billed to a payor, modalities/therapies must be properly documented on the health care record, accurately reported using the most appropriate code, must be medically necessary, and consistent with the chief complaint, clinical findings, diagnosis and treatment plan.

All therapies provided and billed to a payor must be consistent with HNS and contracted payor policies, and the policies of applicable state licensing boards as well as state and federal laws.

Two therapies or modalities per visit, in addition to manipulation, are most commonly accepted as usual and customary. 

There should be a reduction in use of therapies and modalities as the patient's condition improves.  

      Documentation must include:

• Documentation contained in the health care record must clearly establish the medical necessity for all therapies billed to the payor.

• All therapies provided and billed to the payor must be consistent with the patient’s chief complaint, clinical findings, diagnosis and treatment plan.

• There should be a reduction in the use of therapies as the patient’s condition improves.

• Time based codes (constant attendance and therapeutic procedures) are billed in 15 minute increments.  If provided for less than 8 minutes, the service should not be billed to the payor.  Actual time service provided must be documented in the healthcare record.

• Documentation must also include:

• Type of modality
• Area of application (location)
• Setting and frequency
• If time based code, actual time service performed

          Unlisted Modality and/or unlisted service or procedure codes cannot

          be billed  through HNS (including but not limited to 97039). If you need assistance

          in determining the appropriate code to report, please contact your HNS Provider

          Representative for assistance.

           Billing for Electrodes used during electrical stimulation

Electrodes are considered incidental to electrical stimulation by all HNS contracted payors.  Accordingly, it is inappropriate to bill for electrodes when performing electrical stimulation. 

BCBSNC Corporate Medical Policy for Bundling

Electrical Stimulation  / Electrodes –

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement is not allowed for incidental supplies.

  

CIGNA Corporate Medical Policy Code Editing

Electrical Stimulation  / Electrodes –

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement is not allowed for incidental supplies.

 

Written Standards

HNS providers may choose to avoid the time constraints associated with repeatedly meeting the requirements for proper modality documentation, by establishing written standards for the application of each modality used in your practice.

 If you choose to utilize written standards, the rationale for the use of the therapies included in the healthcare record must be consistent with the language in your written standards.  

Please note: If you incorporate written standards in your practice, your written standards should include the following statements:

• The medical necessity for each modality/therapy I have provided and billed to the payor is clearly documented in the patient’s health care record and is consistent with the patient’s chief complaint, clinical findings, diagnoses and treatment plan.

• All therapies provided and billed to the payor are consistent with the chiropractic services covered under the patient’s health care plan.

If you choose to utilize written standards for your practice, you must always document the specific service provided, the specific area(s) treated, and if time-based services are utilized, the actual length the service was provided.