Effective March 1: CMS takes steps to trim the P-Stim whim

by Julia Kyles, CPC on Jan 31, 2020
We thought the medical practice that was accused of billing Medicare for surgically implanted neurostimulators when the doctor had applied P-Stim devices was a fluke. The problem, however, appears to be more widespread, based on an MLN Matters article that warns practices that they should not bill an implantable generator supply code for P-Stim, Stivax, NeuroStim, ANSiStim, E-Pulse or any of the other electro-acupuncture devices on the market.
CMS has caught providers using supply code L8679 (Implantable neurostimulator, pulse generator, any type) to report electro-acupuncture devices, according to the Jan. 29 article. This is inappropriate, CMS stated in no uncertain terms.
Do not report HCPCS code L8679 for the electro-acupuncture device(s). HCPCS code L8679 does not describe devices used for stimulation of acupuncture points.
But CMS didn’t stop with a statement. A 100% prepayment review will go into effect March 1.
Claims for HCPCS code L8679 billed with an appropriate HCPCS/CPT surgical code will be suspended for medical review to verify that coverage, coding, and billing rules have been met.
The article contains a list of appropriate codes, including those for cranial, spinal, peripheral and sacral neurostimulator procedures. Practices that perform these procedures need to make sure their documentation is pristine and be prepared to wait to get paid.
In addition, Medicare administrative contractors (MAC) will begin to reject any claim for L8679 that comes in without an appropriate procedure code.
Practices that inadvertently reported electro-acupuncture with L8679 should come clean to their MAC before it or investigators from the HHS Office of Inspector General have to ask for the money. Returning an improper payment isn't any fun, but it's better than handing over the amount of the payments plus additional fines.
Blog Tags: anti-fraud, CMS, compliance
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