To David Wells: new acupuncture codes

[Guest guest]

Hi David,

 

I've been taking some time to digest the information you posted on

the board, which I very much appreciate you doing. I wanted to ask

you a few questions, if you don't mind.

 

Do you know about how much the range of reimbursement would be per 15

minutes?

 

Also, I noticed that you used the example of seeing 20 patients a

day, and that really made my head spin. Given that you work on the

AAOM Inurance committee, I am wondering if that implies that the

committee is under the impression that 20 patients a day is a common

work-load for an acupuncturist. I see 3 to 4 patients a day, and

although I expect that number to increase, I cannot possibly imagine

seeing anywhere near 20. I would think that about 8 would be a very,

very busy day, and I'm not sure I could see that many. I would be

curious to hear how many patients a day most people see...I seriously

doubt it is anywhere near 20 though.

 

Would you mind commenting on those questions? I have this concern

that the committee had in mind a 20 patient a day work-load and

therefore felt comfortable advocating for a coding system that is

based on that. It seems very unreasonable to me. Please don't feel

like I am jumping on your case---I realize that you are just one

member who was kind enough to post this information for us. But I

would very much like to know more about what the committee was

thinking and how much it was expected that we would be reimbursed per

patient.

 

Thank you,

 

Laura

 

 

Chinese Medicine , acuman1@a...

wrote:

> Here is the reprot provided by AAOM to its members, which may give

a more

> complete idea of what actually is hapening.

> David Molony

>

> 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 valueâ€, 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 patientâ€. 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

servicesâ€.

> 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 matchâ€

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@a... | www.aaom.org

>

>

>

>

>

[Guest guest]

there are many LAc's that are seeing 20 pt a day

alon

 

 

[Guest guest]

I agree with you, Laura.

Do not know how it is 20 patients a day. Only few of

us here in LA have 20 or more. Average number probably

is 8-12 patients a day

Yuri

--- heylaurag <heylaurag wrote:

 

>

> Hi David,

>

> I've been taking some time to digest the information

> you posted on

> the board, which I very much appreciate you doing.

> I wanted to ask

> you a few questions, if you don't mind.

>

> Do you know about how much the range of

> reimbursement would be per 15

> minutes?

>

> Also, I noticed that you used the example of seeing

> 20 patients a

> day, and that really made my head spin. Given that

> you work on the

> AAOM Inurance committee, I am wondering if that

> implies that the

> committee is under the impression that 20 patients a

> day is a common

> work-load for an acupuncturist. I see 3 to 4

> patients a day, and

> although I expect that number to increase, I cannot

> possibly imagine

> seeing anywhere near 20. I would think that about 8

> would be a very,

> very busy day, and I'm not sure I could see that

> many. I would be

> curious to hear how many patients a day most people

> see...I seriously

> doubt it is anywhere near 20 though.

>

> Would you mind commenting on those questions? I

> have this concern

> that the committee had in mind a 20 patient a day

> work-load and

> therefore felt comfortable advocating for a coding

> system that is

> based on that. It seems very unreasonable to me.

> Please don't feel

> like I am jumping on your case---I realize that you

> are just one

> member who was kind enough to post this information

> for us. But I

> would very much like to know more about what the

> committee was

> thinking and how much it was expected that we would

> be reimbursed per

> patient.

>

> Thank you,

>

> Laura

[Guest guest]

Alon

 

Many?

Some have stated that a very high percentage never wind up continuing to

practice because they can;t make a living.

And those that do practice considering again some past posted annual incomes

of the majority....lets just say that it is a sad state of affairs.

The many who see upwards of 20 patients per day are overall only a small

portion of the overall acupuncturists in practice.

And those who see 3-5 per day......they can still make a decent living if the

profession doesn;t let the reimbursement levels go in the toilet.

 

Richard

 

 

In a message dated 12/3/2004 6:18:05 PM Eastern Standard Time,

alonmarcus writes:

 

there are many LAc's that are seeing 20 pt a day

alon

 

 

 

[Guest guest]

I don't know the area you are practicing in. It may be very saturated

but I still think that creative marketing - letting people know what you

have to offer and what an opportunity it is to receive it can work in

any market. You have to be very clear about what you are doing as a

business. I personally believe that acupuncture is a wonder that

everyone should have the opportunity to have. It can prolong your life,

make living life so much more peaceful and enjoyable, and as I believe

get to something very deep inside you - orignal nature which is what

human beings so desire. In order to get people to listen you may have

to focus on disease prevention, relief of chronic pain, fibromyalgia,

rheumatoid arthritis, lups, chronic fatigue - diseases we hardly new

about or heard about 10 or more years ago.

 

I mentioned earlier a book written by Lynn Grodski on marketing therapy

and acupuncture practices How to Build Your Ideal Private Practice. I

believe Honora Wolf (you can do a search on her works) has written

something on practice building. I mentioned David Singer who is a

consultant. I'm sure there are others. Where David Singer may be too

high sales for our acupuncturists you can take from him what works for

you. The point is if we don't start to look at ourselves as a business

as well as a service people will never get the opportunity to know it -

we may leave the field or be working part time in it. This really has

nothing to do with insurance reimbursement. I like that insurance will

be able to reimburse something so maybe more people have access to it,

but it should not be the determining factor that makes or breaks your

business.

 

As to the person who sees 3 or 4 a day - that's a choice. I still see

one an hour and will be shifting to two an hour. Seeing 7 or 8 a day -

one an hour can be very exhausting. When you see more patients 2 and

hr. it can be less so. Some acupuncturists see 4/ hr., they probably

have an assitant. It will all be in your choice. I do think we have to

go to two an hour - in order to move away from a part time income or end

up totally exhausted by week's end.

 

Sincerely,

 

Anne

 

 

 

acudoc11 wrote:

 

>

> Alon

>

> Many?

> Some have stated that a very high percentage never wind up continuing to

> practice because they can;t make a living.

> And those that do practice considering again some past posted annual

> incomes

> of the majority....lets just say that it is a sad state of affairs.

> The many who see upwards of 20 patients per day are overall only a small

> portion of the overall acupuncturists in practice.

> And those who see 3-5 per day......they can still make a decent living

> if the

> profession doesn;t let the reimbursement levels go in the toilet.

>

> Richard

>

>

> In a message dated 12/3/2004 6:18:05 PM Eastern Standard Time,

> alonmarcus writes:

>

> there are many LAc's that are seeing 20 pt a day

> alon

[Guest guest]

Hi Anne,

 

Thanks for your inspiring post. I wish that I could figure out how to

talk to my patients about the benefits that you just described. I

really think that a lot of my patients stop coming when their main

complaint is resolved, and many would benefit from more treatments

(perhaps less often) for the ongoing quality of life issues. But I'm

afraid to talk to them abotu it for fear of sounding like a used car

salesman. I'm curious how other's practice goes...how many clients are

ongoing clients who come many for a " tune-up " , and how often do they

come?

 

Anyway, I do want to get the book you mentioned about marketing your

practice. Sounds great.

 

I have only been in practice for a year, so I really can't complain.

All things considered I think I'm doing fairly well. Its been really

helpful to hear from others what the average of an established

practice is.

 

I really need to cut back on the chatting/counseling....I really enjoy

it (its the social worker in me--), but won't be able able to keep up

with it if I want to get busier.

 

Laura

 

 

Chinese Medicine , Anne Crowley

<blazing.valley@v...> wrote:

>

> I don't know the area you are practicing in. It may be very saturated

> but I still think that creative marketing - letting people know what

you

> have to offer and what an opportunity it is to receive it can work in

> any market. You have to be very clear about what you are doing as a

> business. I personally believe that acupuncture is a wonder that

> everyone should have the opportunity to have. It can prolong your

life,

> make living life so much more peaceful and enjoyable, and as I believe

> get to something very deep inside you - orignal nature which is what

> human beings so desire. In order to get people to listen you may have

> to focus on disease prevention, relief of chronic pain, fibromyalgia,

> rheumatoid arthritis, lups, chronic fatigue - diseases we hardly new

> about or heard about 10 or more years ago.

>

> I mentioned earlier a book written by Lynn Grodski on marketing therapy

> and acupuncture practices How to Build Your Ideal Private Practice. I

> believe Honora Wolf (you can do a search on her works) has written

> something on practice building. I mentioned David Singer who is a

> consultant. I'm sure there are others. Where David Singer may be too

> high sales for our acupuncturists you can take from him what works for

> you. The point is if we don't start to look at ourselves as a business

> as well as a service people will never get the opportunity to know it -

> we may leave the field or be working part time in it. This really has

> nothing to do with insurance reimbursement. I like that insurance will

> be able to reimburse something so maybe more people have access to it,

> but it should not be the determining factor that makes or breaks your

> business.

>

> As to the person who sees 3 or 4 a day - that's a choice. I still see

> one an hour and will be shifting to two an hour. Seeing 7 or 8 a day -

> one an hour can be very exhausting. When you see more patients 2 and

> hr. it can be less so. Some acupuncturists see 4/ hr., they probably

> have an assitant. It will all be in your choice. I do think we

have to

> go to two an hour - in order to move away from a part time income or

end

> up totally exhausted by week's end.

>

> Sincerely,

>

> Anne

>

>

>

> acudoc11@a... wrote:

>

> >

> > Alon

> >

> > Many?

> > Some have stated that a very high percentage never wind up

continuing to

> > practice because they can;t make a living.

> > And those that do practice considering again some past posted annual

> > incomes

> > of the majority....lets just say that it is a sad state of affairs.

> > The many who see upwards of 20 patients per day are overall only a

small

> > portion of the overall acupuncturists in practice.

> > And those who see 3-5 per day......they can still make a decent

living

> > if the

> > profession doesn;t let the reimbursement levels go in the toilet.

> >

> > Richard

> >

> >

> > In a message dated 12/3/2004 6:18:05 PM Eastern Standard Time,

> > alonmarcus@w... writes:

> >

> > there are many LAc's that are seeing 20 pt a day

> > alon

[Guest guest]

Laura: I will email you privately on this.

 

Anne

 

heylaurag wrote:

 

>

>

> Hi Anne,

>

> Thanks for your inspiring post. I wish that I could figure out how to

> talk to my patients about the benefits that you just described. I

> really think that a lot of my patients stop coming when their main

> complaint is resolved, and many would benefit from more treatments

> (perhaps less often) for the ongoing quality of life issues. But I'm

> afraid to talk to them abotu it for fear of sounding like a used car

> salesman. I'm curious how other's practice goes...how many clients are

> ongoing clients who come many for a " tune-up " , and how often do they

> come?

>

> Anyway, I do want to get the book you mentioned about marketing your

> practice. Sounds great.

>

> I have only been in practice for a year, so I really can't complain.

> All things considered I think I'm doing fairly well. Its been really

> helpful to hear from others what the average of an established

> practice is.

>

> I really need to cut back on the chatting/counseling....I really enjoy

> it (its the social worker in me--), but won't be able able to keep up

> with it if I want to get busier.

>

> Laura

[Guest guest]

Laura, I'm not in practice yet but I do feel that relating to your

patients the benefits of OM for quality of life issues would be a great step

in marketing not only for yourself, but for the OM profession as a whole. We

need to start selling our wares for their benefits in entirety. Although

discussing some aspects of Western medical terminology with patients is

important and necessary, I believe that it would benefit OM if more

discussions with patients involved a good dose of Chinese terminology.

Using terms such as yin/yang def., phlegm-damp, heart fire, etc, may seem a

bit confusing to the patent, but it can express to a client that we have

something to offer besides Western medicine's touted " medical-90 day wonder

allopathic OM " .

I used to sell Medicare Supplement insurance to the elderly, often

selling them the higher end, (price), policy if I sincerely believed it be

to their advantage. It often worked. If not on the phone and in front of

people, you'd be amazed at the public's ability to interpret sincerety. Just

don't sound like a car salesman, be yourself, look them in the eye and

you'll do fine with marketing those " tune ups " !

 

Mike Eidson

 

-

" Anne Crowley " <blazing.valley

<Chinese Medicine >

Sunday, December 05, 2004 8:55 PM

Re: To David Wells: new acupuncture codes

 

 

>

>

> Laura: I will email you privately on this.

>

> Anne

>

> heylaurag wrote:

>

> >

> >

> > Hi Anne,

> >

> > Thanks for your inspiring post. I wish that I could figure out how to

> > talk to my patients about the benefits that you just described. I

> > really think that a lot of my patients stop coming when their main

> > complaint is resolved, and many would benefit from more treatments

> > (perhaps less often) for the ongoing quality of life issues. But I'm

> > afraid to talk to them abotu it for fear of sounding like a used car

> > salesman. I'm curious how other's practice goes...how many clients are

> > ongoing clients who come many for a " tune-up " , and how often do they

> > come?

> >

> > Anyway, I do want to get the book you mentioned about marketing your

> > practice. Sounds great.

> >

> > I have only been in practice for a year, so I really can't complain.

> > All things considered I think I'm doing fairly well. Its been really

> > helpful to hear from others what the average of an established

> > practice is.

> >

> > I really need to cut back on the chatting/counseling....I really enjoy

> > it (its the social worker in me--), but won't be able able to keep up

> > with it if I want to get busier.

> >

> > Laura

>

>

>

 

>

>

>

>

>