Is it Chiropractic CPT Code 97014 or 97032 or HCPCS G0283? Understanding This Coding Confusion

Are you using CPT code 97014 in your chiropractic billing? If yes, you need to read this.

In chiropractic treatments, electrical muscle stimulation (EMS) is often used to treat chronic back pain, post-surgical pain, joint pain, arthritis, fibromyalgia, muscle injury from trauma, disease or surgery, nerve inflammation, tendonitis, bursitis, stroke, spinal cord injury, and others.

Types of Electrical Stimulation in Chiropractic Therapy

There are various types of electrical stimulation that can be used to promote healing and enhance muscle function in chiropractic sessions:

1. Electrical Muscle Stimulation (EMS): EMS uses electrical currents to stimulate muscle contractions. This can be used for muscle strengthening, rehabilitation, and pain management.
2. High Voltage Pulsed Current (Electrogalvanic Stimulation): Electrogalvanic stimulation delivers electrical currents to reduce pain, improve blood circulation, and promote tissue healing.
3. Neuromuscular Electrical Stimulation (NMES): NMES targets the nerves and muscles to improve muscle strength, increase range of motion, and enhance neuromuscular coordination.
4. Functional Electrical Stimulation (FES): FES uses electrical currents to activate specific muscles or muscle groups. This therapy can help individuals with muscle weakness regain functional movement and improve their quality of life.
5. Transcutaneous Electrical Nerve Stimulation (TENS): TENS involves the application of low-voltage electrical currents to relieve pain by stimulating the sensory nerves and interrupting pain signals to the brain.

The EMS service is provided to the patient’s nerves or muscles that cannot move by themselves or respond on their own. This helps in promoting healing and stimulating muscle function.

CPT Code 97014 and Electrical Muscle Stimulation

The 97014 chiropractic CPT code is used for an unattended EMS treatment, which is performed in the office but does not require the presence of the chiropractic provider. Unattended electrical stimulation is not a timed service. Chiropractors usually administer EMS for 15- to 30-minute sessions. The definition and use of the 97014 CPT code sound pretty straightforward. 97014 CPT code – Under Supervised Physical Medicine and Rehabilitation Modalities – is also used by physical therapy practices. However, chiropractic providers and billing staff have probably experienced reimbursement complications with this code. Here’s why.

For starters, 97014 is not a valid code when you’re billing Medicare. Chiropractors must use the G0283 procedure code for Medicare patients.

Similarly, if you check the 97014 CPT code reimbursement guideline by Optum, you will find that Optum will not provide reimbursement for 97014. However, unattended electrical stimulation will continue to be a reimbursable service. Providers who use this modality will not receive reimbursement for CPT code 97014. To comply with CMS National Coding Policy, providers should submit the appropriate HCPCS G-code that accurately represents the service provided.

If you check G0283 CPT code reimbursement guidelines by Blue Cross and Blue Shield of Louisiana, the insurance company will apply multiple procedure reductions to codes 95851-95852, 97010-97150, 97169-97596, 97611-97799, 98940-98943 and G0283 when billed on the same day.

Use G0823 for Medicare and not 97014

• On March 1, 2003, the procedure code 97014 electrical muscle stimulation (unattended) became status I, which means this CPT code is: ‘Not valid for Medicare purposes.’
• On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released a notice stating that certain services subject to the therapy cap. The notice stated that ““Services furnished under the Outpatient Therapy (OPT) services benefit – including Speech-Language Pathology (SLP), Occupational Therapy (OT), and Physical Therapy (PT) – are subject to the financial limitations, known as therapy caps, originally required under Section 4541 of the Balanced Budget Act (1997).” This notice is in effect for chiropractors as well. This means now chiropractors will need to report the G0283 CPT code modifier – GP – in order to receive the appropriate denial for secondary insurance purposes.
• Medicare has selected three Healthcare Common Procedure Coding System (HCPCS) codes in 2003 for electrical stimulation (unattended):

G0281 and G0282 HCPCS Codes – These codes would be used for wound care treatment and therefore not appropriate for chiropractic clinics.

G0283 HCPCS Code – Electrical stimulation (unattended), to one or more areas for the indication(s) other than wound care, as part of a therapy plan of care.

Use 97032 for Attended For Electrical Stimulation

The official definition of CPT Code 97032 is: ‘Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes.’ ‘Attended Electrical Stimulation’ requires one on one contact with the patients by the qualified provider only (supervised modality). An example of when to use CPT code 97032 would be a patient who had been in a long leg cast. He was receiving stimulation to the quadriceps and asked to perform terminal knee extension exercises. These types of attended stimulation modalities are often used to assist patients with muscles that are weak or do not function properly. To receive 97032 CPT code reimbursement for such cases, the specific modality or procedure performed, the area of application, and the duration of treatment must be added to the patient documentation.

When the problem arises with the 97014 CPT Code

1. When the secondary insurance wants 97014 and Medicare as primary insurance wants G0283 procedure code, it may cause a problem.

Solution – Most payers recognize the G0283 CPT code, so they will pay it. A quick web search of payer policies reveals that several non-Medicare payers such as United Healthcare require providers to use G0283 rather than 97014.

2. Incorrect usage of 97014 might trigger an audit 

Solution – Thorough documentation to prove medical necessity or necessary is a must for chiropractic service 97014. The patient documentation must illustrate the need for electrical stimulation treatment. The patient SOAP note should clearly mention:

• The patient must have a certified plan of care
• Include objective evidence
• The date of treatment
• The name of the treatment, intervention, or activity provided
• The time spent on services or the total treatment time
• The identity of the individual providing the intervention
• The patient’s pain rating and the location of the pain
• Frequency and intensity of treatment and other details may be included in the plan of care
• The effects of the electrical stimulation
• Progress reports and updated within 30 treatment days of the initial treatment
• The signature and professional identification of the qualified professional who provided or supervised the therapy or procedure

3. Using the 97014 code for attended electrical stimulation when constant contact is not required could trigger an audit.

Solution –  Use the 97014 Chiropractic CPT code when it is an unsupervised modality (unattended). Use the 97032 CPT code when providing attended electrical stimulation. Remember, the 97032 CPT code for chiropractic services is billed in units of 15 minutes each. Use 97032 when hand-held devices are used during the treatment.

4. Using 97014 for Medicare patients will come back as a denial, causing a hold-up in payments

Solution – Medicare will deny your claim containing the 97014 code, explaining that it is an invalid code. When the claim is denied by Medicare due to invalid coding, your claim will neither have patient responsibility nor any payment from the secondary insurance. That’s why when submitting EMS to Medicare, you must use G0283 to receive a proper denial if you need to bill a secondary payer.

Here’s a comparison of the 97014 CPT code reimbursement guidelines:

Here’s a comparison of the 97032 CPT code reimbursement guidelines:

Important Points to Remember When Billing the 97014 and G0283 CPT Codes:

• Different Payment Allowances: Some payers recognize both chiropractic CPT codes (97014 and G0283) and even have different payment allowances for each.
• G0283 Recognition: Most insurance payers recognize the G0283 CPT code, so they might pay for it. If you’re billing Medicare, G0283 CPT code reimbursement depends on the modifier used, geographical location of the provider, and the type of facility where the service is provided.
• Reimbursement Policy Compliance: Follow the reimbursement policy for CPT codes for chiropractors before you bill a payer.
• NCCI Edits and Denials: CMS has National Correct Coding Initiative (NCCI) edits to deny G0283 when billed with G0151. Horizon BCBSNJ has adopted edits to deny 97014 when submitted with G0151.
• Medical Billing Audit Services: Regular chiropractic medical billing audits can help identify and correct coding errors, ensure compliance with payer policies, and optimize reimbursement for services like those billed under CPT codes 97014 and G0283.

Conclusion:

Using the right CPT codes for chiropractic billing including the 97014 and 97032 CPT codes, and the G0283 HCPCS code can help you get reimbursed faster. Incorrect use of chiropractic CPT codes could result in extensive rework and delay in your payments. At zHealth, we have chiropractic billing specialists who can oversee your entire billing work to improve the financial performance of your chiropractic clinic. From reviewing your CPT code for chiropractic services, submitting claims, and to managing denials and accounts receivables, we will handle everything while you provide the best care to your patients. Want to know how zHealth can help you streamline chiropractic billing and increase your revenue, contact us today!

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