How do you bill for acupuncture?
By Marty Kotlar, DC, CHCC, CBCS

I recently hired an acupuncturist. Do you have any coding and billing suggestions?

Billing and coding for acupuncture procedures continue to gain widespread use, and more information has become available. As a result, the American Medical Association (AMA) has made some "refinements" to the acupuncture CPT codes.

The organization has revised the acupuncture codes and added two new guidelines.

REVISED CODES

97811: Acupuncture, one or more needles; without electrical stimulation; each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s).

List this code separately in addition to the code for the primary procedure. The revision notes to perform this procedure without electrical stimulation. Report this add-on code in conjunction with either code 97810 or 97813.

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

Do not report this code in conjunction with 97810 because only one "initial" code may be used.

97814: Acupuncture, one or more needles; with electrical stimulation; each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s).

List this code separately in addition to the code for the primary procedure. The revision notes to perform this procedure with electrical stimulation. Report this add-on code in conjunction with either code 97810 or 97813.

NEW GUIDELINES

Two new guidelines have been added:

1. Report only one CPT code for each 15-minute increment. For the initial increment, either code 97810 (acupuncture, one or more needles; without electrical stimulation; initial 15 minutes of personal one-on-one contact with the patient) or code 97813 (see above) should be reported.

Additionally, report only one initial acupuncture code per date of service, since these services include the treatment, setup, and evaluation necessary to identify the specific acupuncture service(s) necessary for the patient. Therefore, when reporting this service, report only one initial code per date-of-service to identify the complete initial service provided.

For each additional increment of personal one-on-one contact with the patient, use either 97811 or 97814, depending on the use or nonuse of electrical stimulation during that increment.

2. Report evaluation and management (E/M) services separately. Append modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if the patient's condition requires a significant separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the acupuncture services.

The time of the E/M service is not included in the time of the acupuncture service.

To summarize, revised guidelines to the acupuncture codes further simplify the use of the codes by:

• Clarifying the relationship between a "parent" code (such as 97810) and a "child" code (such as 97811) when indentation occurs among related services; and

• Removing references to the number of needles used, in favor of identifying the treatment types provided and the ability to report the use of more than one treatment type (with or without electrical stimulation) per session.

Providers are given the ability to report these services in a more logical method, by identifying a single type of acupuncture according to the method used during that 15-minute increment.

Marty Kotlar, DC, CHCC, CBCS, is president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, through his Web site at www.TargetCoding.com, or by e-mail at drkotlar@targetcoding.com.