The 97014 CPT Code: Understanding This Audit Trigger
- The 97014 CPT code is used for electrical stimulation, but it’s not the only code that covers this procedure.
- Medicare and other insurance carriers require code G0283 to be used.
- Misusing the 97014 CPT code may trigger an audit if it’s used excessively or incorrectly.
- Proper documentation is key to avoiding or acing an audit.
- ChiroTouch helps you bill correctly the first time with streamlined, simplified coding.
Electrical stimulation is a common service offered by chiropractors, and it’s often covered by insurance. Medicare doesn’t reimburse for electrical stimulation under the 97014 CPT code, though they may reimburse for the procedure under code G0283.
Chiropractors must be careful to use the right code, especially when treating Medicare patients. Here’s what to know about the 97014 CPT code and why it’s often a challenge for billing departments.
What Is the 97014 CPT Code?
The 97014 CPT code is used for unattended electrical stimulation. This treatment uses an electrical current and electrodes placed on the skin to make a single muscle or muscle group contract. The contractions help to increase muscle strength and promote blood flow to the muscle to assist in healing.
The 97014 CPT code is for an unattended treatment, which is performed in office but does not require the presence of the chiropractor. This is different from the 97032 CPT code, which is for attended electrical stimulation and requires constant supervision of the treatment.
Why 97014 Is a Potential Audit Trigger
The definition of the 97014 CPT code sounds pretty straightforward. However, chiropractic billing departments have probably experienced their fair share of reimbursement complications.
For starters, 97014 is not valid for any patient with Medicare. In accordance with CMS guidelines, chiropractors must use the code G0283 for Medicare patients. This code is designed to cover unattended electrical stimulation that is not a part of wound care treatment. Other carriers may also require the use of the G0283 code instead of 90714.
What makes this code an audit trigger is its alignment with your documentation notes. First and foremost, electrical stimulation must be used in conjunction with other therapies. E-stim alone to treat neuropathies caused by underlying systemic diseases is not usually considered medically necessary and reasonable. Rather, the use of nerve blocks and electrical stimulation to alleviate neuropathies is largely considered investigational and is therefore not usually a covered treatment.
Electrical stimulation includes the following forms:
- Transcutaneous electrical nerve stimulation, or TENS
- Muscle stimulation
- Neuro-muscular stimulation
- Interferential current/medium current, or IFC
- High voltage pulsed current (electrogalvanic stimulation)
Unattended electrical stimulation is not a timed service, though it is typically administered in 15- to 30-minute sessions. This varies from the 97032 CPT code, which applies to attended electrical stimulation. This code is billed for in units of 15 minutes each and only applies when hand-held devices are held for the duration of the treatment.
This does not apply to sessions where a patient received supervised electrical stimulation for safety reasons. Because you are not constantly administering the treatment to the patient and are only watching them receive it, it cannot be billed as attended electrical stimulation.
Something else to consider is whether you’re billing for this service outside of your normal billing practices. Any change in how you bill is sure to catch the attention of an auditor. If you’re billing incorrectly for a chiropractic service in hopes of having it approved for reimbursement, that break in consistency might be picked up by an auditor anyway.
There’s also the risk of miscoding a treatment using G0281 or G0282 instead of G0283. Both G0281 or G0282 apply to electrical stimulation, but for the purpose of wound care. These codes are inappropriate in a chiropractic setting and should be avoided.
How To Use the 97014 CPT Code Correctly
Mastering Medicare billing codes (or any other billing codes, for that matter) can be tricky. There are a few things you can do to ensure you’re using the proper codes at the right time and improve your reimbursements.
First, understand the appropriate use case of 97014. Using it for Medicare patients is sure to come back as a denial, causing a hold-up in payment. Also, using the code for attended electrical stimulation when constant contact is not required could trigger an audit. This code is used less often and may provoke more scrutiny.
Also, thorough documentation to prove medical necessity is a must in the event of an audit. If you happen to incorrectly bill for this code or deviate from your normal billing patterns and trigger an audit, your next best action is to have the proper documentation that illustrates the need for electrical stimulation treatment.
Included in this documentation should be the type of electrical stimulation you’re using, as well as the areas you’re treating and its purpose. For example, if you are using electrical stimulation for pain or muscle weakness, include this in the patient file. Also, include details about the objective rating of strength and the functional deficits you’re correcting. The patient’s pain rating, the location of the pain, and the effects of the electrical stimulation can also support you in the event of an audit.
How ChiroTouch Simplifies Billing Processes
Using the right CPT codes for billing (including the 97014 CPT code) can help you get reimbursed faster and support a more profitable practice. However, the opposite is also true — using the wrong codes can call for extensive rework and delay your payments.
At ChiroTouch, we’re helping chiropractors bill correctly the first time and save time in the process. With a streamlined billing workflow that simplifies insurance coding, our software takes the guesswork out of billing. As a holistic practice management platform, we help you connect patient health data to insurance and payment processes. Have all the information you need to easily pass audits — or avoid them altogether.
See how ChiroTouch is revolutionizing chiropractic billing. Book a demo today.