Tampa, FL, October 15, 2014: Healthcare providers across the nation share the frustration of dealing with insurance carriers on coverage and claims issues. Inconsistent application or interpretation of Medicare DMERC guidelines, Milliman USA Care guidelines or HCSC Medical Policies lead to coverage of a patient’s prescribed therapies in one instance by one carrier and denial of the identical claim by another. Sometimes because of a factual gap in the documentation the same carrier will treat what seem to be identical patients differently. All to the detriment of patient care.
Recognizing this problem and having studied a number of claims denials and the results of some appeals, STYMCO has determined that better, more complete coverage of patient needs can be had through more careful documentation, particularly as it related to electrotherapy treatment and the use of conductive garments to enhance said treatments. As part of this review STYMCO considered revamping its prescription forms but after consulting with some of its providers it has determined that mindfulness of the following information and better use of the current form could solve the problem of inconsistent coverage and claims decisions and work to the patient’s benefit.
Will generally be approved for treatment of acute pain immediately after surgery or for chronic pain that has resisted other forms of medical management for more than 90 days. Use of a TENS unit to treat Acute, non-surgical pain that has not become chronic is considered investigative and experimental. (What? The common man would say if the electrotherapy helps with chronic intractable pain and with acute pain immediately after surgery, why doesn’t it help with pain from day 30 to 90 or acute pain generally? But then common sense does run our healthcare system).
Providers who are prescribing a TENS unit for post-surgical pain should mark the surgery box on the previous treatment line, use the icd code 318 AND write in the “other” line something like “for acute post-surgical pain”.
Providers wanting to prescribe electrotherapy for chronic pain management should consider noting in the “other” are how long they have been treating the patient for the condition. When the treatment efforts have been for less than ninety days STYMCO will use this injury or inception date as a tool and may ask for progress notes or other subsequent data to support that other pain management techniques such as drugs and PT have not proven sufficient.
Carriers will approve the use of a conductive garment as adjunct to an approved electrotherapy treatment IF: the individual has a large area requiring treatment or a large number of site to stimulate making conventional use of leads or wires impractical; the site is difficult to reach; or the patient has a co-existing medical condition, usually a skin condition, precluding use of leads or tapes. Providers prescribing the use of conductive garments are encouraged to consider spelling out the reason for the need of the garment on the “other” line so there is no doubt of the medical need for the garment.
STYMCO Medical appreciated the input it received from Providers while it was undergoing this examination of coding and documentation practice and is encouraged by the cooperation it has received from Providers concerning Progress Notes and is hopeful that together the Provider-STYMCO team will be able to continue to improve patient satisfaction with its services.
About STYMCO Medical
Thank you for your interest in STYMCO Medical, a Durable Medical Equipment (DME) company that distributes electrotherapy devices to patients for home medical use. STYMCO Medical is based in Tampa, Florida. Our focus is to distribute quality electroceutical technologies to physicians and patients throughout the United States and provide them with non-surgical and non-invasive options for the treatment of pain due to acute and chronic injury, as well as post-surgical pain.
At STYMCO Medical, we bring the latest non-surgical treatments from companies around the world to our patients and physicians. Our safe non-surgical treatments may help patients suffering from pain and may also help rehabilitate muscles after injury. It is hoped that by offering our technologies throughout the country physicians can improve the quality of care received by their patients.
STYMCO Medical, LLC is dedicated to providing quality products and services to our patients. Through our professional, highly qualified employees, we give our patients the highest quality care available in the industry.
STYMCO Medical, LLC along with our employees, are committed to education and training in order to improve our skills and maintain a level of excellence of care and continued safety to our patients.