new acupuncture codes

[Guest guest]

Things are worse than you think. I just recieved an e-mail from AAOM

explaining the new codes. They are feeling triumphant about their

achievement. I don't know who they are representing but it is not me.

 

I am furious. I don't want to practice acupuncture in 15 minute intervals. I am

not running a production line acupuncture practice. What is this non-sense. If

I am dealing with insurance companies I will have to list these 15 minute

intervals and justify my use of points.

 

I am including the AAOM missive so you can see it for yourselves.

 

 

November 23, 2004

We now have new CPT codes!

 

 

 

Greetings Colleagues!

 

After almost two years of work, a coalition led by the American Association of

Oriental Medicine that included the American Chiropractic Association, the

American Association of Medical Acupuncturists, and the AOMAlliance,

succeeded in updating the CPT codes for acupuncture. This was a long and

difficult process. Many thanks to Roger Brooks and Gene Bruno of the AAOM

and to the representatives of the other organizations who helped us obtain

these codes.

 

The new codes are:

97180 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, with re-insertion(note) of needles.

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, with re-insertion of needles.

(Please buy the 2004 CPT book to get a complete list of codes and

descriptors).

 

Note: The use of the term " re-insertion " does not mean that we should violate

sterile technique and re-insert the same needles. The term reflects the

intention of the CPT committee that the additional 15 minute period(s) of

acupuncture include location, marking and cleaning points, hand-washing,

insertion, manipulation, removal and disposal of needles. In other words, the

additional 15 minute period(s) reflect the work value of performing

acupuncture.

 

 

 

There are two differences between the current codes and the new codes:

 

1. One difference is that the new codes allow for reporting and reimbursement

of acupuncture or electroacupuncture in 15-minute increments. We were

previously limited to one increment of acupuncture (or electroacupuncture)

reimbursement per visit. Now, in more complex cases, we can bill for

additional time in 15-minute increments. (There is no limit as to the number of

15-minute increments in the CPT book however you must be able to

document the medical necessity of each service with your SOAP notes).

2. The other difference is that the procedures of the acupuncture or

electroacupuncture were previously not defined in terms of their work value,

therefore the insurance industry had no basis for deciding how much to pay

for our services. In defining the " relative unit value " , we provide a basis for

insurance carriers to compare our work to that of other health providers and

pay us accordingly. By describing the " work " of acupuncture (including the

level of skill required, the difficulty and risks involved), and then breaking

that

work into timed increments similar to physical therapy or other timed codes,

we can expect to rise with the tide when other timed services increase in

value. This way, we do not fight alone against the insurance companies.

 

What does " 15-minutes " mean?

It is very important to note that " 15 minutes " is defined as " personal one-on-

one contact with the patient " . This means that you are not only in the room

with the patient, you are actively performing a medically necessary activity

that is a component of acupuncture or electroacupuncture. The time that the

needles are retained is specifically excluded for reimbursement. " Personal

one-on-one contact with the patient " does not mean hanging out with the

patient and talking about their 5-element preferences or their love life for

that

matter. We don't get paid for counseling under these codes. We don't get paid

for evaluation and management of the patient under these codes except for

the " usual preservice and postservice work associated with the acupuncture

services " . These codes are for performing the procedures of acupuncture or

electroacupuncture, not for the initial history and exam or subsequent re-

examination (more on this later). You can think of this as the time your hands

are doing some component of the acupuncture service.

 

 

 

" Personal one-on-one contact with the patient " is limited to; selecting,

locating, marking and cleaning the points, washing your hands, inserting and

manipulating the needles, removing and properly disposing the needles. The

only exception to this is in the case of a patient who must be continuously

monitored. An example is a patient who is nauseated and may vomit at any

time. If you must be on hand to remove the needles during the course of

treatment, you may count that as face-to-face time. Another example would be

a patient who is getting distal acupuncture for an inflammatory joint condition

like sciatica (Yao Tong Xue) or bursitis of the shoulder (St. 38), and you are

directing the patient to move while the needles are in place to enhance and

evaluate the effectiveness of the treatment. Or, perhaps you are treating

someone with low blood pressure and you must monitor the pulse so that you

can suddenly remove the needles to avoid fainting.

 

Evaluation and Management

You are also being paid to provide the " usual preservice and postservice

work associated with the acupuncture services " that accompanies a repeat

visit. The usual preservice work means that you greet the patient, take an

interval history, i.e., " How have you been since your last visit? " and re-

examine any positive findings from your initial exam that you need to monitor

to adjust your treatment (such as rechecking tongue and pulse). At the end of

the acupuncture or electroacupuncture, you chart what you did and any

instructions you gave to the patient. This is the usual postservice work. In

other words, the level of effort that goes into performing the activities

reflected

in SOAP notes is included in the work value of these codes. The preservice

and postservice times are expected to be about 3 minutes each.

 

When the patient has suffered a significant new trauma or change in

symptoms, or if 4-6 weeks have passed and you feel you need to perform a

re-examination to monitor the effectiveness of treatment, you may (if your

scope allows) perform a re-examination and bill an Evaluation and

Management code (i.e., Office visit). It is not appropriate to bill an office

visit

with every acupuncture treatment.

 

How long should the treatment take?

Based on our survey, we think that the average treatment will be two units of

time, with one or three units being less common. No one is suggesting that

you use a stopwatch and note the times in your patient chart, but if you are

treating 20 patients a day, it would be ridiculous to claim that they all

received

an hour of your undivided attention.

 

 

 

Please don't change your clinical procedures to maximize your

reimbursement. Do what you normally do to achieve the best clinical result

and charge what you think your services are worth. Whatever you do,

document your care in your SOAP notes. In the case of a dispute, you must

have good SOAP notes to make your case that the time you spent was

medically necessary). Medical necessity is not documented simply by listing a

lot of points. You must show that the patient had subjective complaints and

objective findings that required treatment to the points you selected. The CPT

supplement has examples of treatments and how to code them. You can buy

that from the AMA.

 

Electroacupuncture and Acupuncture Together

The CPT book doesn't allow you to bill for a " mix and match " of acupuncture

and electroacupuncture on the same visit. This is to prevent acupuncturists

from charging for inserting the needles (acupuncture) and then attaching

electrodes to those same needles (electroacupuncture). The insurance

industry does not want to pay twice for inserting the same needles. To prevent

that confusion, they simply set up the codes so that you will only be

reimbursed for billing either units of acupuncture or units of

electroacupuncture, not both. So what do you bill if you perform an initial 15

minutes of electroacupuncture and a second 15 minutes of acupuncture

without electrical stimulation? You bill both as electroacupuncture. As

inaccurate as it appears, the relative unit committee decided that this is the

best way to handle the issue. The differential in reimbursement for the

additional period of acupuncture versus electroacupuncture is small enough

to be the lesser of two evils in the eyes of the relative unit committee.

 

How much will I be paid?

This question cannot be answered. Insurance companies will determine what

they think is fair. In the case of HMO's, the payment is by contract, so the new

codes may not have much effect. Some carriers may decide that they will only

pay for one increment of service in a day. Some may decide not to pay you at

all. If your patients are as unhappy as you are about your reimbursement, they

may advocate on your behalf. You may decide not to accept insurance

reimbursement from carriers who are too restrictive.

 

What is the relative unit value of our services?

The work value of a 15-minute acupuncture treatment is .60. This compares

with the work value of .21 for 15 minutes of ultrasound. This is an excellent

valuation for our services and represents a real triumph for the profession.

Because our codes are now timed, our work value will rise with the tide as

other professions fight to increase reimbursement for their services.

 

Additional 15 minutes of acupuncture has a work value of .55.

Electroacupuncture is valued at .65 and additional electroacupuncture is

valued at .60. The additional time codes do not include additional pre- and

postservice time. It is assumed that the additional periods of insertion do not

require additional pre- and postservice work.

 

How much should I charge?

Regardless of the new CPT codes or Relative Unit Values assigned to these

codes, you must decide what your services are worth. Neither the AMA nor

the insurance industry is setting your fees by assigning a work value to your

services. You set your fees based on your own business needs and what the

average cash-paying patient is willing to pay for your services. In other words,

it is the free market, not the insurance company that determines the value of

your services.

 

David Wells, D.C., L.Ac.

AAOM Insurance Committee

[Guest guest]

Bravo again for a correct evaluation.

 

The overall majority of acupuncturists DO NOT sit FACE TO FACE with the

patient for 15 minutes at a time whether it be for the first or subsequent

intervals. They might look in on the patient to check. Even with electro

acupuncture.

 

AOMNC has been against these new codes by the AMA/CPT. We have written to

them in the past telling them our objectioon. AOMNC is the ONLY and LARGEST

national acupuncture coalition organization speaking against. AOMNC supports

Alternative Link's ABC Codes which are about to be approved by the CMS/DHHS (US

federal Government) under HCPCS.

 

Furthermore......one of the largest healthcare insurers is working out

arrangements to adopt the ABC Codes into service. Additionally THE largest

reviewer

of auto-PIP claims nationwide (85%) is also getting ready to adopt the ABC

Codes.

 

So you'all understand WHY the western medical monopolized coding system

throws a few pebbles into the mix. Makes it seem as IF they are doing something

great for acupuncture while there are many shortfalls and dangers not to mention

ulterior motives.

 

I borrowed a quote from a friend with slight modifications which states that

we see this coding system offer 4 (four) acupuncture codes for 3-5,000 years

of effective traditional wholistic healthcare versus 100 years of (mostly

barbaric) allopathic medicine with 8,000 (eight thousand) + codes.

 

Richard

 

In a message dated 11/27/2004 5:21:47 AM Eastern Standard Time,

cmszinnia writes:

Things are worse than you think. I just recieved an e-mail

explaining the new codes. They are feeling triumphant about their

achievement. I don't know who they are representing but it is not me.

 

I am furious. I don't want to practice acupuncture in 15 minute intervals. I

am

not running a production line acupuncture practice. What is this non-sense.

If

I am dealing with insurance companies I will have to list these 15 minute

intervals and justify my use of points.

 

 

 

[Guest guest]

I would love to know the specifics of HOW to bill this way. Will it be like

massage where they bill for 4 units of treatment?

 

 

 

_____

 

acudoc11 [acudoc11]

Saturday, November 27, 2004 6:36 AM

Chinese Medicine

Re: new acupuncture codes

 

 

 

Bravo again for a correct evaluation.

 

The overall majority of acupuncturists DO NOT sit FACE TO FACE with the

patient for 15 minutes at a time whether it be for the first or subsequent

intervals. They might look in on the patient to check. Even with electro

acupuncture.

 

AOMNC has been against these new codes by the AMA/CPT. We have written to

them in the past telling them our objectioon. AOMNC is the ONLY and LARGEST

national acupuncture coalition organization speaking against. AOMNC supports

 

Alternative Link's ABC Codes which are about to be approved by the CMS/DHHS

(US

federal Government) under HCPCS.

 

Furthermore......one of the largest healthcare insurers is working out

arrangements to adopt the ABC Codes into service. Additionally THE largest

reviewer

of auto-PIP claims nationwide (85%) is also getting ready to adopt the ABC

Codes.

 

So you'all understand WHY the western medical monopolized coding system

throws a few pebbles into the mix. Makes it seem as IF they are doing

something

great for acupuncture while there are many shortfalls and dangers not to

mention

ulterior motives.

 

I borrowed a quote from a friend with slight modifications which states that

 

we see this coding system offer 4 (four) acupuncture codes for 3-5,000 years

 

of effective traditional wholistic healthcare versus 100 years of (mostly

barbaric) allopathic medicine with 8,000 (eight thousand) + codes.

 

Richard

 

In a message dated 11/27/2004 5:21:47 AM Eastern Standard Time,

cmszinnia writes:

Things are worse than you think. I just recieved an e-mail

explaining the new codes. They are feeling triumphant about their

achievement. I don't know who they are representing but it is not me.

 

I am furious. I don't want to practice acupuncture in 15 minute intervals.

I

am

not running a production line acupuncture practice. What is this non-sense.

 

If

I am dealing with insurance companies I will have to list these 15 minute

intervals and justify my use of points.

 

 

 

[Guest guest]

I can well understand your anger at these codes Zinnia.

 

In effect, this is saying that the whole healing interaction that goes

on between an acupuncturist and a patient - the empathy, the rapport,

the listening, the solace, the lifestyle and dietary advice, even the

time you take to arrive at a dianosis and treatment strategy is not

worth anything.

How dare they? It is not my " hands " that practice acupuncture - it is

my entire self - mind, body and spirit. The AAOM have reduced our

profession to basically that of a low-level technician - someone who

just mechanically sticks needles in.

 

What morons. I know the big state regulators and vested financial and

orthodox medical interests would like to biomedicalise ewverything we

do, but this is simply handing them the rope & noose with which to

hang us.

 

I'm expecting similar things when state regulation hits the UK.

 

Godfrey Bartlett

(England)

 

Chinese Medicine , " zinnia "

<cmszinnia@e...> wrote:

>

>

> Things are worse than you think. I just recieved an e-mail from AAOM

> explaining the new codes. They are feeling triumphant about their

> achievement. I don't know who they are representing but it is not me.

>

> I am furious. I don't want to practice acupuncture in 15 minute

intervals. I am

> not running a production line acupuncture practice. What is this

non-sense. If

> I am dealing with insurance companies I will have to list these 15

minute

> intervals and justify my use of points.

>

> I am including the AAOM missive so you can see it for yourselves.

>

>

> November 23, 2004

> We now have new CPT codes!

>

>

>

> Greetings Colleagues!

>

> After almost two years of work, a coalition led by the American

Association of

> Oriental Medicine that included the American Chiropractic

Association, the

> American Association of Medical Acupuncturists, and the AOMAlliance,

> succeeded in updating the CPT codes for acupuncture. This was a long

and

> difficult process. Many thanks to Roger Brooks and Gene Bruno of the

AAOM

> and to the representatives of the other organizations who helped us

obtain

> these codes.

>

> The new codes are:

> 97180 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, with re-insertion(note) of needles.

> 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, with re-insertion of needles.

> (Please buy the 2004 CPT book to get a complete list of codes and

> descriptors).

>

> Note: The use of the term " re-insertion " does not mean that we

should violate

> sterile technique and re-insert the same needles. The term reflects the

> intention of the CPT committee that the additional 15 minute

period(s) of

> acupuncture include location, marking and cleaning points,

hand-washing,

> insertion, manipulation, removal and disposal of needles. In other

words, the

> additional 15 minute period(s) reflect the work value of performing

> acupuncture.

>

>

>

> There are two differences between the current codes and the new codes:

>

> 1. One difference is that the new codes allow for reporting and

reimbursement

> of acupuncture or electroacupuncture in 15-minute increments. We were

> previously limited to one increment of acupuncture (or

electroacupuncture)

> reimbursement per visit. Now, in more complex cases, we can bill for

> additional time in 15-minute increments. (There is no limit as to

the number of

> 15-minute increments in the CPT book however you must be able to

> document the medical necessity of each service with your SOAP notes).

> 2. The other difference is that the procedures of the acupuncture or

> electroacupuncture were previously not defined in terms of their

work value,

> therefore the insurance industry had no basis for deciding how much

to pay

> for our services. In defining the " relative unit value " , we provide

a basis for

> insurance carriers to compare our work to that of other health

providers and

> pay us accordingly. By describing the " work " of acupuncture

(including the

> level of skill required, the difficulty and risks involved), and

then breaking that

> work into timed increments similar to physical therapy or other

timed codes,

> we can expect to rise with the tide when other timed services

increase in

> value. This way, we do not fight alone against the insurance companies.

>

> What does " 15-minutes " mean?

> It is very important to note that " 15 minutes " is defined as

" personal one-on-

> one contact with the patient " . This means that you are not only in

the room

> with the patient, you are actively performing a medically necessary

activity

> that is a component of acupuncture or electroacupuncture. The time

that the

> needles are retained is specifically excluded for reimbursement.

" Personal

> one-on-one contact with the patient " does not mean hanging out with the

> patient and talking about their 5-element preferences or their love

life for that

> matter. We don't get paid for counseling under these codes. We don't

get paid

> for evaluation and management of the patient under these codes

except for

> the " usual preservice and postservice work associated with the

acupuncture

> services " . These codes are for performing the procedures of

acupuncture or

> electroacupuncture, not for the initial history and exam or

subsequent re-

> examination (more on this later). You can think of this as the time

your hands

> are doing some component of the acupuncture service.

>

>

>

> " Personal one-on-one contact with the patient " is limited to;

selecting,

> locating, marking and cleaning the points, washing your hands,

inserting and

> manipulating the needles, removing and properly disposing the

needles. The

> only exception to this is in the case of a patient who must be

continuously

> monitored. An example is a patient who is nauseated and may vomit at

any

> time. If you must be on hand to remove the needles during the course of

> treatment, you may count that as face-to-face time. Another example

would be

> a patient who is getting distal acupuncture for an inflammatory

joint condition

> like sciatica (Yao Tong Xue) or bursitis of the shoulder (St. 38),

and you are

> directing the patient to move while the needles are in place to

enhance and

> evaluate the effectiveness of the treatment. Or, perhaps you are

treating

> someone with low blood pressure and you must monitor the pulse so

that you

> can suddenly remove the needles to avoid fainting.

>

> Evaluation and Management

> You are also being paid to provide the " usual preservice and

postservice

> work associated with the acupuncture services " that accompanies a

repeat

> visit. The usual preservice work means that you greet the patient,

take an

> interval history, i.e., " How have you been since your last visit? "

and re-

> examine any positive findings from your initial exam that you need

to monitor

> to adjust your treatment (such as rechecking tongue and pulse). At

the end of

> the acupuncture or electroacupuncture, you chart what you did and any

> instructions you gave to the patient. This is the usual postservice

work. In

> other words, the level of effort that goes into performing the

activities reflected

> in SOAP notes is included in the work value of these codes. The

preservice

> and postservice times are expected to be about 3 minutes each.

>

> When the patient has suffered a significant new trauma or change in

> symptoms, or if 4-6 weeks have passed and you feel you need to

perform a

> re-examination to monitor the effectiveness of treatment, you may

(if your

> scope allows) perform a re-examination and bill an Evaluation and

> Management code (i.e., Office visit). It is not appropriate to bill

an office visit

> with every acupuncture treatment.

>

> How long should the treatment take?

> Based on our survey, we think that the average treatment will be two

units of

> time, with one or three units being less common. No one is

suggesting that

> you use a stopwatch and note the times in your patient chart, but if

you are

> treating 20 patients a day, it would be ridiculous to claim that

they all received

> an hour of your undivided attention.

>

>

>

> Please don't change your clinical procedures to maximize your

> reimbursement. Do what you normally do to achieve the best clinical

result

> and charge what you think your services are worth. Whatever you do,

> document your care in your SOAP notes. In the case of a dispute, you

must

> have good SOAP notes to make your case that the time you spent was

> medically necessary). Medical necessity is not documented simply by

listing a

> lot of points. You must show that the patient had subjective

complaints and

> objective findings that required treatment to the points you

selected. The CPT

> supplement has examples of treatments and how to code them. You can buy

> that from the AMA.

>

> Electroacupuncture and Acupuncture Together

> The CPT book doesn't allow you to bill for a " mix and match " of

acupuncture

> and electroacupuncture on the same visit. This is to prevent

acupuncturists

> from charging for inserting the needles (acupuncture) and then

attaching

> electrodes to those same needles (electroacupuncture). The insurance

> industry does not want to pay twice for inserting the same needles.

To prevent

> that confusion, they simply set up the codes so that you will only be

> reimbursed for billing either units of acupuncture or units of

> electroacupuncture, not both. So what do you bill if you perform an

initial 15

> minutes of electroacupuncture and a second 15 minutes of acupuncture

> without electrical stimulation? You bill both as electroacupuncture. As

> inaccurate as it appears, the relative unit committee decided that

this is the

> best way to handle the issue. The differential in reimbursement for the

> additional period of acupuncture versus electroacupuncture is small

enough

> to be the lesser of two evils in the eyes of the relative unit

committee.

>

> How much will I be paid?

> This question cannot be answered. Insurance companies will determine

what

> they think is fair. In the case of HMO's, the payment is by

contract, so the new

> codes may not have much effect. Some carriers may decide that they

will only

> pay for one increment of service in a day. Some may decide not to

pay you at

> all. If your patients are as unhappy as you are about your

reimbursement, they

> may advocate on your behalf. You may decide not to accept insurance

> reimbursement from carriers who are too restrictive.

>

> What is the relative unit value of our services?

> The work value of a 15-minute acupuncture treatment is .60. This

compares

> with the work value of .21 for 15 minutes of ultrasound. This is an

excellent

> valuation for our services and represents a real triumph for the

profession.

> Because our codes are now timed, our work value will rise with the

tide as

> other professions fight to increase reimbursement for their services.

>

> Additional 15 minutes of acupuncture has a work value of .55.

> Electroacupuncture is valued at .65 and additional

electroacupuncture is

> valued at .60. The additional time codes do not include additional

pre- and

> postservice time. It is assumed that the additional periods of

insertion do not

> require additional pre- and postservice work.

>

> How much should I charge?

> Regardless of the new CPT codes or Relative Unit Values assigned to

these

> codes, you must decide what your services are worth. Neither the AMA

nor

> the insurance industry is setting your fees by assigning a work

value to your

> services. You set your fees based on your own business needs and

what the

> average cash-paying patient is willing to pay for your services. In

other words,

> it is the free market, not the insurance company that determines the

value of

> your services.

>

> David Wells, D.C., L.Ac.

> AAOM Insurance Committee

[Guest guest]

Do you really think that any organization can create CPT codes for

empathy, rapport, listening or solace? The reality is that insurance

companies pay for tangible procedures and that isn't likely to change.

If you feel that AAOM has the power to take away your ability to provide

empathy, build rapport, listen to or take solace with your patients then

you need to take a closer look at were these things come from. They

don't come from any political organization, but from yourself as a

healer.

 

Be grateful you can practice this medicine openly and legally. We have

come a long way in 30 years (in the U.S.), largely thanks to those

people who take on the bureaucratic and political issues around CM.

They have to play a game which isn't always pretty. I'm glad there are

people willing to do it so I don't have to. As long as I can openly and

legally practice what I'm trained to do, then what happens in my

treatment room is really just between me and my patients. What CPT

codes exist have little or nothing to do with how I will practice this

medicine.

 

Chris

 

 

acu_qichina [acu]

Sunday, November 28, 2004 8:15 AM

Chinese Medicine

Re: new acupuncture codes

 

 

 

I can well understand your anger at these codes Zinnia.

 

In effect, this is saying that the whole healing interaction that goes

on between an acupuncturist and a patient - the empathy, the rapport,

the listening, the solace, the lifestyle and dietary advice, even the

time you take to arrive at a dianosis and treatment strategy is not

worth anything.

How dare they? It is not my " hands " that practice acupuncture - it is

my entire self - mind, body and spirit. The AAOM have reduced our

profession to basically that of a low-level technician - someone who

just mechanically sticks needles in.

 

What morons. I know the big state regulators and vested financial and

orthodox medical interests would like to biomedicalise ewverything we

do, but this is simply handing them the rope & noose with which to

hang us.

 

I'm expecting similar things when state regulation hits the UK.

 

Godfrey Bartlett

(England)

 

 

 

 

 

 

 

[Guest guest]

Alon Marcus wrote:

 

>

> >>>>>All you need to do in that case is charge for office visit. You

> are confusing a procedure code (which now acupu is the same as all

> other procedures and which is very good for us because we got very

> good relative value) and an office visit. If you truly do this at each

> visit, which is not the usual case, than you can try to charge for

> consultation codes. You will need extensive notes to support it.

>

>

> Alon:

 

 

Wasn't there a restricition mentioned on charging for an office visit

each time? This makes sense to me since you are at least in contact two

fifteen minute intervals - 15 office visit, 15 procedure. Many

practioners from my school are in contact 1 hr, some with only one

patient during that hour.

 

So my question is - it is your understanding that we could charge for an

office visit each time? What is the code for that?

 

Thanks,

 

Anne

 

 

> http://babel.altavista.com/

>

>

> and

> adjust accordingly.

>

> If you , it takes a few days for the messages to stop being

> delivered.

>

> Messages are the property of the author. Any duplication outside the

> group requires prior permission from the author.

>

>

>

[Guest guest]

Well said, Chris.

 

Christopher Vedeler wrote:

 

> Do you really think that any organization can create CPT codes for

> empathy, rapport, listening or solace? The reality is that insurance

> companies pay for tangible procedures and that isn't likely to change.

> If you feel that AAOM has the power to take away your ability to provide

> empathy, build rapport, listen to or take solace with your patients then

> you need to take a closer look at were these things come from. They

> don't come from any political organization, but from yourself as a

> healer.

>

> Be grateful you can practice this medicine openly and legally. We have

> come a long way in 30 years (in the U.S.), largely thanks to those

> people who take on the bureaucratic and political issues around CM.

> They have to play a game which isn't always pretty. I'm glad there are

> people willing to do it so I don't have to. As long as I can openly and

> legally practice what I'm trained to do, then what happens in my

> treatment room is really just between me and my patients. What CPT

> codes exist have little or nothing to do with how I will practice this

> medicine.

>

> Chris

>

>

> acu_qichina [acu]

> Sunday, November 28, 2004 8:15 AM

> Chinese Medicine

> Re: new acupuncture codes

>

>

>

> I can well understand your anger at these codes Zinnia.

>

> In effect, this is saying that the whole healing interaction that goes

> on between an acupuncturist and a patient - the empathy, the rapport,

> the listening, the solace, the lifestyle and dietary advice, even the

> time you take to arrive at a dianosis and treatment strategy is not

> worth anything.

> How dare they? It is not my " hands " that practice acupuncture - it is

> my entire self - mind, body and spirit. The AAOM have reduced our

> profession to basically that of a low-level technician - someone who

> just mechanically sticks needles in.

>

> What morons. I know the big state regulators and vested financial and

> orthodox medical interests would like to biomedicalise ewverything we

> do, but this is simply handing them the rope & noose with which to

> hang us.

>

> I'm expecting similar things when state regulation hits the UK.

>

> Godfrey Bartlett

> (England)

 

[Guest guest]

One insurance firm here in the UK called HSA, simpy reimburses the

patient for the fees charged by the acupuncturist. Depending on the

level of annual premiums paid there is a cut off when the total amount

reaches a certain limit. As a member of the British Acupuncture

Council, they simply accept the receipts I give to patients. There is

no question of coding, 15 minute packets or limitations to the types

of condition treated.

 

The redefintion of acupuncture as a 15 minute 'procedure' is totally

inappropriate . Accepting this control from the biomedical community

can create perverse incentives in a clinical setting - ie to do no

more than what you will be reimbursed for. In particular, any

referrals from orthodox doctors will almost certainly try to

constrain your practice within what they - rather than you as a

professional in your field - consider is 'acupuncture'. If you accept

that, it is selling out.

 

The same argument goes for research. The most meaningful acupuncture

research is based on the practices that go in in the normal treatment

room, not some over-simplified version that fits in with the limited

knowledge of a medical researcher, using methodology more appropriate

to the drug industry.

[Guest guest]

Alon, You said:

 

If you truly do this at each visit, which is not the usual case, than

you can try to charge for consultation codes. You will need extensive

notes to support it.

 

That says it all....I've been trying to stay open minded about this,

but what you just said summed up the problem for me. IT ABSOLUTELY IS

usually the case that I and most of the practitioners I know check in

fully with our patients along with the treatment. We need to in order

to asses what has and has not changed and in order to TREAT WHAT WE

SEE. I hope I don't sound overly antagonistic here---I don't want to

come across that way (and its easy to come across more that way than

you intend in writing), but your post came across in a way that really

surprised me as an acupuncturist. Are you saying that you usually

just have your patients come in, lay down, and stick needles in them?

 

Also, anything that requires " extensive notes " to be achieved that

used to be as simple as writing a number on the bill is not a good

thing. This is the regular way that most of practice---it is not an

exception to the rule.

 

This really does look like a disaster for our profession....not to be

overly mellowdramatic. I don't get it. How could the AAOM have

WANTED this to happen?

 

Laura

 

 

Chinese Medicine , " Alon Marcus "

<alonmarcus@w...> wrote:

>

> How dare they? It is not my " hands " that practice acupuncture - it is

> my entire self - mind, body and spirit. The AAOM have reduced our

> profession to basically that of a low-level technician - someone who

> just mechanically sticks needles in.

> >>>>>All you need to do in that case is charge for office visit. You

are confusing a procedure code (which now acupu is the same as all

other procedures and which is very good for us because we got very

good relative value) and an office visit. If you truly do this at each

visit, which is not the usual case, than you can try to charge for

consultation codes. You will need extensive notes to support it.

>

>

>

[Guest guest]

Hey Doc, what you are saying here made a heck of a lot of sense. We

really shouldn't be surprised that the system is treating us the way

that the system treats people. My only concern is if I am suddenly

going to have a major reduction in my income, frankly. Anyone know

how much they are going to pay for those 15 minutes? Also, is this

something that is suppose to open the door to being covered by

medicare? If so, all in all, I think its a good thing. I realize

that the more we become a part of the system the more the system will

run us...and believe me, that TERRIFIES ME----especially as an

herbalist (I can only imagine what's going to happen THERE----actually

its already happening). But I think that it will open up so many

doors for us that maybe its worth it.

 

If this kind of thing allows me to have more patients then I will have

the freedom to choose who I give more time to. As it is I give lots

of time to all my patients because I have lots of time (so far 4

patients a day is pretty typical for me). But they don't all NEED as

much time as I give.

 

Naturally this post contradicts the post I just wrote, but your words

were persuasive to me.

 

Laura

 

 

 

Chinese Medicine , Doc <Doc@s...> wrote:

> Richard,

> My .02

>

> We are presented with a reality that -wishful thinking aside -says

that we need to fit into their system (the one that has been in place

for insurance billing since before the first Ac license was issued in

the US) and not expect them to change to suit us.

> I am not a fan of the AAOM but saying that they have sold out is

simply not true -in this case.

>

> This is called a foot in the door and those of us who say *I won't

play until they invite me all the way in as an equal partner* are

going to grow old waiting outside.

> I will use this imperfect foot in the door to help my patients who

otherwise could not afford health care.

>

> Is your argument about which set of numbers we use?

> Great, present exactly what your codes mean and all of the details

as the AAOM folks just did. No tirades, no propaganda just present the

cold hard facts and let us compare them.

> Set the numbers side by side and let us look at the pros and cons.

>

> Insurance codes by their very nature reduce us all to a set of cold

unfeeling numbers. It is the same system that has created a thousand

other inequities of which this is but a minor example. 3000 children

die every day from hunger while the US and UK and EU each throw away

enough food daily to feed them extravagantly. Millions in the US have

no access to health care and an almost equal per capita rate exists in

Europe. If that and the system that create such thinking are what you

are upset about then lets get together and bring the change.

>

> Doc

>

>

>

>

>

>

>

> Meet the all-new My – Try it today!

>

>

[Guest guest]

These kind of statements are nothing more than flaming from an obiosu

propagandist and not worth wasting the time nor the energy in responding.

 

 

 

 

In a message dated 11/28/2004 1:28:32 PM Eastern Standard Time,

Doc writes:

 

AOMNC and AAOM are at war with each other and have both IMO stuped to rather

less than ethical tactics,

 

My understanding is that the AOMNC is a tiny group with very little

membership or clout. I know lots of folks in both the Alliance (which i belong

to) and

the AAOM but have never even met a single AOMNC in the entire USA.

Would you please disclose in your letters on this issue your involvment with

this group and not hide your agenda on this issue.

 

Doc

 

 

 

[Guest guest]

Doc

 

If you REALLY want to know the truth then spend the .02 of your time and look

with your own eyes. It has been spoken about for years and while many like to

play the 'prove it to me' game......they will be left in the dust when it

settles.

 

As for a workable (not perfect) set of codes built for ALL of CAM (with a

special and sizeable section for Ap/OM) go and research for yourself the ABC

Codes and find out what you are missing.

 

Like Alternative Link who designed this innovative 4,000 CAM coding system

and fought the system including the AMA/CPT and now which sits at the edge of a

new era in the US about ready for US Government approval.....AOMNC with its

supposed 'tiny' membership has been at the forefront in moving forward a US

Federal Acupuncture Bill AND also sits at the forefront of 'being doers' by

having

filed the first Anti-trust Racketeering lawsuit against ten of the largest

HMOs in the US.

 

Do you really expect people who have known me for years to buy into a late

comer calling what we have accomplished as..... wishful thinking? Lets stop

trying to pull everyone's leg by these ludicrous statements.

 

You are a big boy...right? No one especially me...needs to hold your hand

through the logical exercise of comparative analysis.

 

Richard

 

 

 

 

 

In a message dated 11/28/2004 1:53:32 PM Eastern Standard Time,

Doc writes:

 

Richard,

My .02

 

We are presented with a reality that -wishful thinking aside -says that we

need to fit into their system (the one that has been in place for insurance

billing since before the first Ac license was issued in the US) and not expect

them to change to suit us.

I am not a fan of the AAOM but saying that they have sold out is simply not

true -in this case.

 

This is called a foot in the door and those of us who say *I won't play

until they invite me all the way in as an equal partner* are going to grow old

waiting outside.

I will use this imperfect foot in the door to help my patients who otherwise

could not afford health care.

 

Is your argument about which set of numbers we use?

Great, present exactly what your codes mean and all of the details as the

AAOM folks just did. No tirades, no propaganda just present the cold hard facts

and let us compare them.

Set the numbers side by side and let us look at the pros and cons.

 

Insurance codes by their very nature reduce us all to a set of cold unfeeling

numbers. It is the same system that has created a thousand other inequities

of which this is but a minor example. 3000 children die every day from hunger

while the US and UK and EU each throw away enough food daily to feed them

extravagantly. Millions in the US have no access to health care and an almost

equal per capita rate exists in Europe. If that and the system that create such

thinking are what you are upset about then lets get together and bring the

change.

 

Doc

 

 

 

[Guest guest]

A couple of points:

 

1) As an American practitioner, this all is, of course, vitally

interesting. But also learning something of what the situation is like in,

for instance, the UK is of interest. And what appears to be a dialog on the

relative subjective and objective aspects of different treatment styles

should be of interest to many of us.

 

2) Sun Nov 28, 2004 12:34 pm, " acu_qichina " <acu@q...> wrote:

 

> The redefintion of acupuncture as a 15 minute 'procedure' is totally

inappropriate . Accepting this control from the biomedical community can

create perverse incentives in a clinical setting - ie to do no more than

what you will be reimbursed for.

 

My view is that the control is exerted less from the

bio-or-whatever-medical community, but rather from the medical industry.

I.e. insurance companies and the administrators of HMOs (health maintenance

organizations), PPOs, etc., who are business people (even when some have

background as practitioners). From what I hear, MDs themselves, by and

large, find themselves just a victimized by this as some in this forum.

Some MDs organize their work around what they are reimbursed for. So do

some acupuncturists. Other accommodate, and go about their service as what

they perceive to be something of a calling.

 

3) What does it all really mean in my practice?

 

Billing a 97810 for routine treatments in a series, when cumulative change

is taking place and the treatment protocol changes only slightly (as it

usually does).

 

For cases with more extensive, time-spaced manipulations, or Luo vessel or

other special OM techniques, bill a 97810 and a 97811, documenting as much.

(Not more work than done now.)

 

With a significant change of condition, or additional condition or

complication, or after 4-6 routine treatments, carrying out a re-evaluation

and billing a 99213 or 99214 (evaluation, established patient). Again

little change. And, as usual, taking an hour or more at initial intake and

billing a 99205 or 99204 (new patient evaluations).

 

The big question, of course, is what monetary values get assigned to 'work

value'. This will impact the patients more than myself, as I do not

contract with insurance plans, but bill on behalf of the patients for

out-ot-network services. If one tries to build a practice largely as member

of networks, the monetary valuation issue will be more critical.

 

After witnessing many of the reactions voiced in this forum, it was good to

actually read the message from the AAOM (written by David Wells), for

perspective. I think the joint efforts of the AAOM, ACA (chiros), AMAA

(MDs) and the Alliance can be trusted to be in our best interests, given

the overall situation - the power and direction of the medical 'industry'.

 

Sad that so much or the reaction seen here appears to precede careful data

gathering and analysis of inputs from various authoritative sources as to

how it all works and what it means.

 

 

[Guest guest]

How dare they? It is not my " hands " that practice acupuncture - it is

my entire self - mind, body and spirit. The AAOM have reduced our

profession to basically that of a low-level technician - someone who

just mechanically sticks needles in.

>>>>>All you need to do in that case is charge for office visit. You are

confusing a procedure code (which now acupu is the same as all other procedures

and which is very good for us because we got very good relative value) and an

office visit. If you truly do this at each visit, which is not the usual case,

than you can try to charge for consultation codes. You will need extensive notes

to support it.

 

 

 

[Guest guest]

Do you really think that any organization can create CPT codes for

empathy, rapport, listening or solace? The reality is that insurance

companies pay for tangible procedures and that isn't likely to change.

>>>Just read the CPT code book. You think psychotherapy is not paid for?

 

 

 

[Guest guest]

So my question is - it is your understanding that we could charge for an

office visit each time? What is the code for that?

>>>It would be very difficult to justify one hour contact every time. If your

state scope allows you to do consultation you should use psychotherapy codes.

Again you will need to document all you are talking about etc. I bet it would be

very difficult for you to do so each time. You cant just repeat the same thing

over and over. Acupuncture is a procedure code. Other codes are used for other

purposes. The CPT book has all the information you need. The bigger problem is

state scoop of practice etc.

 

 

 

[Guest guest]

and an almost equal per capita rate exists in Europe.

 

>>>IS that true? Most of EU as national health care

 

[Guest guest]

That says it all....I've been trying to stay open minded about this,

but what you just said summed up the problem for me. IT ABSOLUTELY IS

usually the case that I and most of the practitioners I know check in

fully with our patients along with the treatment.

>>>Checking in fully does not usually mean in most practices, and I have seen

many in the last 25 years,one hour of one to one talking, or even 30 minuets of

one to one talking. Checking in is part of any continuos modality. If you charge

for 30 minutes of acupuncture this usually include the limited office visit

components just as when you do continual manual therapy, physical therapy,

injection therapy etc. When and if you spend more time than the usual checking

in, then you incorporate an office visit with the procedure codes. I think you

guys are confusing issues.