How To Use HCPCS Code E0764

HCPCS code E0764 describes a specific medical procedure known as functional neuromuscular stimulation (FNS). This procedure involves the transcutaneous stimulation of sequential muscle groups in order to facilitate ambulation in individuals with spinal cord injuries. The entire system used for this purpose is covered under this code, after the completion of a training program.

1. What is HCPCS E0764?

HCPCS code E0764 is used to identify the specific procedure of functional neuromuscular stimulation for ambulation in individuals with spinal cord injuries. It involves the use of transcutaneous stimulation to activate sequential muscle groups, allowing for walking and mobility. This code is specific to the entire system used for this purpose, including the necessary computer control.

2. Official Description

The official description of HCPCS code E0764 is “Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The procedure of functional neuromuscular stimulation (FNS) with HCPCS code E0764 begins with the placement of electrodes on the skin over the targeted muscle groups.
2. The electrodes are then connected to a computer-controlled device that delivers electrical stimulation to the muscles.
3. The stimulation is applied in a sequential manner, activating specific muscle groups in a coordinated pattern to facilitate walking.
4. The intensity and duration of the stimulation are adjusted based on the individual’s needs and response.
5. Patients who undergo this procedure have typically completed a training program to learn how to use the FNS system effectively.

4. When to use HCPCS code E0764

HCPCS code E0764 should be used when billing for the functional neuromuscular stimulation procedure for ambulation in individuals with spinal cord injuries. It is important to note that this code is applicable only after the completion of a training program, indicating that the patient has received the necessary education and instruction on using the FNS system.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E0764, healthcare providers should ensure that the following documentation is included:

• A detailed description of the procedure performed, including the specific muscle groups targeted and the duration of the stimulation.
• Evidence of the patient’s completion of a training program for using the FNS system.
• Any relevant medical records or documentation supporting the medical necessity of the procedure for the individual patient.

6. Historical Information and Code Maintenance

HCPCS code E0764 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996, indicating that it has been in use for a significant period of time. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code E0764 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions regarding coverage and reimbursement for this procedure.

8. Examples

Here are five examples of when HCPCS code E0764 should be billed:

1. A 45-year-old male with a spinal cord injury undergoes functional neuromuscular stimulation to improve his ability to walk independently.
2. A 30-year-old female with a history of spinal cord injury receives functional neuromuscular stimulation as part of her rehabilitation program.
3. A 50-year-old male with a spinal cord injury completes a training program for functional neuromuscular stimulation and begins using the system for ambulation.
4. A 35-year-old female with a spinal cord injury undergoes functional neuromuscular stimulation to enhance her mobility and quality of life.
5. A 60-year-old male with a spinal cord injury receives functional neuromuscular stimulation to improve his walking ability and reduce dependence on assistive devices.