Question to Healthcare Fraud Shield
I have an outpatient surgery center doing P-Stim (auricular stimulation) for back pain and using CPT 64555 (percutaneous neurostimulator – peripheral nerve). P-stim is FDA approved for acupuncture and is a small device that can be done in a physician’s office. My situation is that I have a surgery center billing us (facility claims) and the rendering provider billing (professional claims). Not much is written about using CPT 64555 for p-stim. There is apparently an unpublished AMA letter that speaks to it, but no one is able to locate it! How is using CPT 64555 a misrepresentation here?
Any chance you may have encountered this situation before and could offer some advice? I need something a bit more solid to build a case on!
-Healthcare Fraud Shield Reader
Answer
This is very interesting. We watched a quick youtube video on the procedure which we’ve linked here if you haven’t seen it (http://www.youtube.com/watch?v=P_Ro5kxnbgg). You can take a couple different approaches. First of all, this procedure is not appropriate for an ASC setting. No anesthesia is required. (I hope you aren’t seeing anesthesia claims as well!) Check your policies and member’s benefits as they may speak to appropriateness of ASCs for minor procedures. Secondly, it appears that this would fall under the category of acupuncture with electrical stimulation or possibly experimental/investigational. It also does not appear to fit the code description of implantation of an electrode. They are simply placing needles in the ear. One source we read suggested billing the unlisted code CPT 64999. Ideally, if your plan could quickly develop a medical policy that would help stop the bleeding. This looks like a trend we may be seeing a lot of in the future! Thank you for sharing.
-Healthcare Fraud Shield