Acup codes

[Guest guest]

Hello-

 

Could someone please run the new acup. billing

codes again, please?

 

John Garbarini

[Guest guest]

David Wells, DC, LAc

 

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

 

 

AAOM

PO Box 162340

Sacramento, CA 95816

866-455-7999 Toll Free

info | www.aaom.org

 

-

John Garbarini

Chinese Traditional Medicine

Tuesday, December 28, 2004 1:12 PM

Acup codes

 

 

 

Hello-

 

Could someone please run the new acup. billing

codes again, please?

 

John Garbarini

 

 

 

 

 

http://babel.altavista.com/

 

and adjust

accordingly.

 

 

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