new acupuncture codes: the good side...

[Guest guest]

Does anyone know the argument FOR the new acupuncture codes? Surely

if the AAOM worked to get this done they have a reason, whether their

reasoning is accurate or not.

 

 

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