CPT 97032 - Electrical Stimulation (attended)

 

CPT 97032 - Electrical Stimulation (attended)

 

(Time-based Code)

 

CPT defines CPT code 97032 as "Application of modality to one or more areas; stimulation (manual), each 15 minutes."

 

CPT code 97032 is a constant attendance code. Constant attendance modality codes are used to report various physical agents applied to the patient for the purpose of producing therapeutic changes to biological tissue. The services described by these codes require direct one-on-one contact by the provider. Throughout the procedure, the provider is required to maintain visual, verbal, and/or manual contact with the patient, and the provider cannot be performing another procedure while performing this one.

 

Constant attendance therapies are time-based, and billed in 15-minute increments. Only the actual time of the provider's direct contact with the patient providing these services count toward total time. (If a time-based code is provided for less than 8 minutes, the service should not be billed to the payor.) 

 

HNS Policies: Documentation/Billing
When performed and billed to a payor, modalities/therapies must be properly documented in the health care record and accurately reported using the most appropriate code.

 

When performed and billed to a payor, modalities/therapies must be medically necessary and consistent with the chief complaint/clinical findings, diagnoses and treatment plan.

 

Documentation in the health care record must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.

 

For ALL modalities and therapies, documentation must include:

  • Type of modality

     

  • Rationale

     

  • Area of application (specific region treated)

     

  • Setting and frequency (as applicable)

     

  • If time based code, actual time service performed

  

During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.

 

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

 

Modifiers Needed:
Importantly, when reporting 97032 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append 97032 with modifier GP.

 

Please click here
for the HNS NCCI Edit - Modifier Help Sheet,
which is a list of therapy codes requiring special modifiers.