Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 Hi TCM Group Member, Just wondering if you charge a second 97811 when billing insurance companies. One practitioner I spoke with said if she uses over 20 needles she can justify it. How often do you charge it x2. How do you justify it? Are you running into reimbursement problems with any insurance companies? Thanks for any help with this. Cheers, Dave V Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 It wouldn’t matter if you used 1000 needles, if they were used in one 15-minute set, it would only warrant a single 97810 code. To bill a second 97811 code, you’d have to do 3 SEPARATE groups of needle insertions. For example, I have billed a second 97811 when I have done a front side set of needles (then let them cook for 20 minutes), a back side set of needles (and cook again for 20 minutes) and a follow up with a single needle with manipulation and ROM of an affected joint (like ST38 and shoulder movement for 5 minutes of so). This would qualify. This is 3 separate needlings. The original wording for these codes was VERY clear that numbers of needles were irrelevant. Some companies reimburse (always auto accident PIPs). If you are a preferred provider, your company might have a policy that omits payments for this 3rd code (or 2nd 97811 or 97814). Some companies require that you send your chart notes indicating why you needed a 3rd code, and want to see evidence of it in your notes. I hope that helps. barb _____ Chinese Medicine Chinese Medicine On Behalf Of dmvitello01 Wednesday, September 19, 2007 8:04 AM Chinese Medicine Billing a second 97811 code Hi TCM Group Member, Just wondering if you charge a second 97811 when billing insurance companies. One practitioner I spoke with said if she uses over 20 needles she can justify it. How often do you charge it x2. How do you justify it? Are you running into reimbursement problems with any insurance companies? Thanks for any help with this. Cheers, Dave V Version: 7.5.487 / Virus Database: 269.13.22/1015 - Release 9/18/2007 11:53 AM Version: 7.5.487 / Virus Database: 269.13.22/1015 - Release 9/18/2007 11:53 AM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 Hi Dave, I agree with barbara. The number of needles do not matter to the ins. co. They have it set up more as a time factor. In fact the Insurance code says " one or more needles " . If you do the time, bill it and don't worry about the ins. co. Thanks, Elie TCM Directory http://www.tcmdirectory.com Chinese Medicine , " Barbara Beale " <bbeale wrote: > > It wouldn't matter if you used 1000 needles, if they were used in one > 15-minute set, it would only warrant a single 97810 code. To bill a > second 97811 code, you'd have to do 3 SEPARATE groups of needle insertions. > For example, I have billed a second 97811 when I have done a front side set > of needles (then let them cook for 20 minutes), a back side set of needles > (and cook again for 20 minutes) and a follow up with a single needle with > manipulation and ROM of an affected joint (like ST38 and shoulder movement > for 5 minutes of so). This would qualify. This is 3 separate needlings. > The original wording for these codes was VERY clear that numbers of needles > were irrelevant. > > > > Some companies reimburse (always auto accident PIPs). If you are a > preferred provider, your company might have a policy that omits payments for > this 3rd code (or 2nd 97811 or 97814). Some companies require that you > send your chart notes indicating why you needed a 3rd code, and want to see > evidence of it in your notes. > > > > I hope that helps. > > > > barb > > > > _____ > > Chinese Medicine > Chinese Medicine On Behalf Of > dmvitello01 > Wednesday, September 19, 2007 8:04 AM > Chinese Medicine > Billing a second 97811 code > > > > Hi TCM Group Member, > > Just wondering if you charge a second 97811 when billing insurance > companies. One practitioner I spoke with said if she uses over 20 > needles she can justify it. How often do you charge it x2. How do > you justify it? Are you running into reimbursement problems with any > insurance companies? Thanks for any help with this. > > Cheers, > Dave V > > > > > > > Version: 7.5.487 / Virus Database: 269.13.22/1015 - Release Date: 9/18/2007 > 11:53 AM > > > > > > Version: 7.5.487 / Virus Database: 269.13.22/1015 - Release Date: 9/18/2007 > 11:53 AM > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2007 Report Share Posted September 19, 2007 Dave, Billing a second unit of 97811 implies that you're spending a total of 45 minutes of one-on-one contact time with the patient (i.e., the first 15 minutes is coded 97810 with two additional 15 minute units of 97811) and manipulating and/or " reinserting " needles during each of these 15 minute units. The number of needles isn't relevant but will generally correlate with time. Your charting should indicate how this time was spent. But if you're simply looking for a way to justify billing for more time with a patient than you actually spend, this is insurance fraud and you're on your own. In reviewing disciplinary actions here in California, I see a few practitioners a year get their licensed revoked because of it. All it takes is for one unhappy patient to raise a stink. My strong advice is to bill what you do and to do what you bill. --Bill. -- Bill Mosca, LAc San Francisco CA mosca On Sep 19, 2007, at 8:03 AM, dmvitello01 wrote: > Hi TCM Group Member, > > Just wondering if you charge a second 97811 when billing insurance > companies. One practitioner I spoke with said if she uses over 20 > needles she can justify it. How often do you charge it x2. How do > you justify it? Are you running into reimbursement problems with any > insurance companies? Thanks for any help with this. > > Cheers, > Dave V > > > > Subscribe to the fee online journal for TCM at > Times http://www.chinesemedicinetimes.com > > Help build the world's largest online encyclopedia for Chinese > medicine and acupuncture, click, http:// > www.chinesemedicinetimes.com/wiki/CMTpedia > > http:// > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside > the group requires prior permission from the author. > > Please consider the environment and only print this message if > absolutely necessary. > Quote Link to comment Share on other sites More sharing options...
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