Acupuncture Billing --> was RE: Insurance and Billing Patient Directly

[Guest guest]

Helen,

Thanks for the info.

Some of the CPT coding I've seen says for personal one-on-one contact -- does inserting the needles and then leaving the room and rechecking later count toward that?

Just curious how everyone interprets that code.

http://www.acucouncil.org/new_cpt_2005_acupuncture_codes.htm

October 27, 2004 - The AMA has recently released its new 2005 CPT codes, which include a significant change to the acupuncture and electroacupuncture codes.

A year-and-a-half after inviting acupuncturists to participate in a special CPT advisory sub-committee, the AMA has released its new 2005 CPT codes, which include a change to acupuncture and electroacupuncture codes.

The following information has been cut and pasted directly from the AMA's CPT® 2005 website:

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Acupuncture

97810 Acupuncture, one or more needles, without electrical stimulation; initial 15 minutes of

personal one-on-one contact with the patient

97811 each additional 15 minutes of personal one-on-one contact with the patient

(List separately in addition to code for primary procedure)

(Use 97811 in conjunction with 97810)

(Do not report 97810, 97811 in conjunction with 97813 or 97814)

(Evaluation and Management services may be reported separately, using the modifier 25, if the patient’s condition requires a significant separately identifiable E/M service, above and beyond the usual preservice and postservice work associated with the acupuncture services. The time of the E/M service is not included in the time of the acupuncture service.)

97813 Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes of personal

one-on-one contact with the patient

97814 each additional 15 minutes of personal one-on-one contact with the patient

(List separately in addition to code for primary procedure)

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We have yet to receive a hard copy, and so do not know if 97812 and 97815 are reserved for "unattended" acupuncture and electroacupuncture. That would be important, as dividing current single billing code and fee into two or more billing codes and fees should not change the fees being currently charged for treatment. However, complicated or time-consuming cases could theoretically be charged more, and simple cases to be charged less.

97810 and 97813 (preparation, insertion, and initial manipulation) are likely to be more heavily weighted in fee schedules than 97811 and 97814 (final manipulation and needle removal), but by how much is incertain. For example, if someone is currently charging $100 per electroacupuncture treatment, they might consider charging $70 for the first fifteen minutes (97813) required to insert the needles, manipulate the needles, connect the electrostim device, and adjust the electrostim. and $30 for the last fifteen minutes (97814) required to shut off and detach the electrostim, and remove the needles. Or, they might charge $60/$40 or $50/$50, since no relative ratings have been suggested or established at this time.

Code

CPT Definition

Clinical Procedure

97810

Acupuncture, one or more needles, without electrical stimulation; initial 15 minutes of personal one-on-one contact with the patient

routine brief re-exam and re-assessment of a patient's response to the previous treatment, modify treatment plan accordingly, locate points, clean points, insert and manipulate needles

-

-

allow patient to rest quietly with needles inserted

97811

each additional 15 minutes of personal one-on-one contact with the patient

manipulate and remove needles, chart and progress notes

97813

Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes of personal one-on-one contact with the patient

routine brief re-exam and re-assessment of a patient's response to the previous treatment, modify treatment plan accordingly, locate points, clean points, insert needles, manipulate the needles, connect the electrostim device, and adjust the electrostim

-

-

allow patient to rest quietly with needles inserted and electrostimulation device active

97814

additional 15 minutes of personal one-on-one contact with the patient

shut off and detach the electrostim, manipulate and remove the needles, chart and progress notes

As stated in the CPT, first patient visits that require a history, examination, and diagnosis would be billed under an E/M codes 99201-99205 (using the modifier -25 for when treatment is also provided on the same date), which is the usual and customary procedure for most acupuncturists.

The "usual preservice and postservice work associated with the acupuncture services" referenced in the codes should be understood to mean the routine brief re-exam and re-assessment of a patient's response to the previous treatment, minor modifications to the treatment, and hygienic protocol, insertion, electrostim adjustment, removal of clips and needles, chart and progress notes, etc.

It would not include a thorough re-examination and re-assessment that resulted in significant findings or changes, and that would be billable under E/M codes 99211-99215.

It is important that our profession define the meaning of any terms that are vague or undefined.

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http://www.accupuncture.com/news/cptcodes_jan2005.htm

CPT codes for acupuncture effective January 2005

Press Release

New Reporting Method for Acupuncture Services to Begin in January

Beginning Jan. 1, 2005, there will be a new reporting method for acupuncture services. Effective on that date, CPT codes 97780 (acupuncture, one or more needles; without electrical stimulation) and 97781 (acupuncture, one or more needles; with electrical stimulation) will be deleted.Four new codes have been developed for reporting acupuncture services. Like the deleted codes of 97780 and 97781, the new codes are separated into acupuncture services with and without electrical stimulation. However, in addition to these distinctions, the reporting of acupuncture services will now be reflected in 15-minute intervals, as well as a separate reporting method for the initial versus additional 15 minutes of treatment.The codes themselves are outlined as such:

97810: Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.

97811: Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with reinsertion of needle(s) (List separately in addition to code for primary procedure).

97813: Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.

97814: Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with reinsertion of needle(s) (list separately in addition to code for primary procedure).

Acupuncture is reported based on 15-minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement.If no electrical stimulation is used during a 15-minute increment, use 97810, 97811. If electrical stimulation of any needle is used during a 15-minute increment, use 97813, 97814Evaluation and management services may be reported separately, using modifier 25, if the patient's condition requires a significantly separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with acupuncture services. The time of the E/M service is not included in the time of the acupuncture service.

For more detailed information on CPT Code changes, click here:

aomAlliance6405 43rd Avenue Ct. NW, Ste. BGig Harbor, WA 98335Phone: , Fax: www.aomalliance.org

Thanks

Locke, MD

From: [mailto: ] On Behalf Of Helen YangSent: Sunday, June 15, 2008 3:12 PMTo: practiceimprovement1 Subject: RE: Insurance and Billing Patient Directly

Elaine, I have done acupuncture for more than ten years. Some insurance co would reimburse $25 to $30 PER 15 MIN SESSSION. Most pts need 45 to 60 min treatment, so it would be ($25 to $30) x 4= $100 to $120. Good luck with your new clinic. Helen

To: From: elaine2md@...Date: Sat, 14 Jun 2008 20:05:03 -0800Subject: Re: Insurance and Billing Patient Directly

I am also going to be doing Ap but have not started my practice yet. There are some insurance co here that cover AP but I understand the fee is so low (?$30 but I am not sure) is it not worth it. Hence I decided to be out of network because if I were network, I can't charge more than what the insurance co offers. I can't survive on $30 a visit. Anyone else seen this w insurance co?

On 6/14/08, Locke's in Colorado <lockekcomcast (DOT) net> wrote:

Anyone know how this works?

My wife (an MD) is doing acupuncture.

Patient has insurance.

Insurance doesn't specifically cover acupuncture but gives the patient a 1.7% discount on the EOB.

I'm not even sure how that works -- but the insurance isn't paying -- but says we can't charge any more than the discounted rate they are showing.

It would seem if they don't cover it, they don't cover it.

Anyway -- the cash discount is cheaper for the patient than the insurance discount.

So can we charge the patient directly for the discounted cash fee?

It would seem that we can.

Anyone else bump up against this quirk?

Locke, MD

-- M.D.www.elainemd.comYou only go through this life but once. Go in the directions of your dreams and live the life you've imagined.

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