Insurance (U.S.A.) Billing Question

[Guest guest]

Would appreciate input regarding insurance billing in the U.S. Have heard

conflicting advice regarding coding. Several acupuncturists I know bill for both

evaluation (or office visit) in addition to acupuncture for EACH visit.

However, at an insurance seminar recently, the instructor said to bill for the

first visit the evaluation and acu, but on subsequent visits, acu services only.

Is it common practice to bill for both? Is this 'legal' according to the

insurance companies? Thanks for the advice.

[Guest guest]

Your billing needs to reflect the time spent accurately. In the current code

97810, which covers the first 15 minutes, a small amount of consultation is

included. However, if the client wants more time to discuss the treatment

course, or wants the change what is being treated and the visit takes longer, I

do bill additional consult time. If I do more than 1 treatment, say, I first do

the front, and then turn the client over and do shu points, I will bill for an

additional procedure, usually 97811. You need to know how the codes are defined.

Do not bill for anything you don't do, AND document in the files what you have

done, meaning, if you bill 2 procedures, and additional consultation, your

treatment notes need to reflect that.

 

Regards,

Angela Pfaffenberger, Ph.D.

 

angelapfa

 

www.InnerhealthSalem.com

 

Phone: 503 364 3022

-

eastwestacup

Chinese Medicine

Thursday, September 17, 2009 12:44 PM

Insurance (U.S.A.) Billing Question

 

 

Would appreciate input regarding insurance billing in the U.S. Have heard

conflicting advice regarding coding. Several acupuncturists I know bill for both

evaluation (or office visit) in addition to acupuncture for EACH visit. However,

at an insurance seminar recently, the instructor said to bill for the first

visit the evaluation and acu, but on subsequent visits, acu services only. Is it

common practice to bill for both? Is this 'legal' according to the insurance

companies? Thanks for the advice.

 

 

 

 

 

 

[Guest guest]

It is not standard practice to bill for E/M codes on each visit. The assumption

is that you do your evaluation and then spend the next x weeks treating,

followed by another re-evaluation in a month/4-6 weeks and another set of office

visits. BTW, the acu codes are not simply timed but must also include insertion

or what they call re-insertion of needles. If you practice a style that puts

all needles in at same time for front and then later back, you will only be able

to bill for two codes, one for the initial and another for the extra set. Hope

this helps. Glad that you took the seminar, schools do not deal with this issue

well.

 

Michael W. Bowser, DC, LAc

 

 

Chinese Medicine

eastwestacup

Thu, 17 Sep 2009 19:44:18 +0000

Insurance (U.S.A.) Billing Question

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Would appreciate input regarding insurance billing in the U.S.

Have heard conflicting advice regarding coding. Several acupuncturists I know

bill for both evaluation (or office visit) in addition to acupuncture for EACH

visit. However, at an insurance seminar recently, the instructor said to bill

for the first visit the evaluation and acu, but on subsequent visits, acu

services only. Is it common practice to bill for both? Is this 'legal'

according to the insurance companies? Thanks for the advice.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________

Insert movie times and more without leaving Hotmail®.

http://windowslive.com/Tutorial/Hotmail/QuickAdd?ocid=TXT_TAGLM_WL_HM_Tutorial_Q\

uickAdd_062009

 

 

[Guest guest]

With regards to the acupx codes - the information given so far in this

thread is not accurate. The acupx codes are time-based, face-to-face

contact. The reference to " re-insertion " does not mean what most people in

our profession think it means. If you spend 45 minutes actively needling a

patient, then you bill 3 increments of 15 minutes (using the initial 15

minute acupx or e-acupx code, followed by one of the add'l 15 min acupx or

e-acupx codes).

 

It doesn't matter if you've only done " two " acupuncture procedures (meaning

a front and back tx). If it took you 30 minutes to do the front treatment

and 15 minutes to do the back treatment, that is 45 minutes of total active

needling, and that is how you bill the visit. This was clarified by the AMA

back in 2005.

 

The Medical Acupuncture Association website has had this clarification

posted for 4 years:

http://www.medicalacupuncture.org/cptassistant.pdf

 

Remember, that whatever you have to do while in the process of active

needling to be able to safely perform your treatment is considered part of

the active needling process. If, while needling, you have to palpate the

channel, that's part of the the active needling process. If, while needling,

you have to palpate for ah shi, or for the motor point, or for which

location is more tender, or where you want to cross-fiber needle the muscle,

etc...that's all part of active needling. If, while needling, you need to

check their pulse to see how your treatment is affecting the flow of energy

through the channels, that's part of active needling. (Note: I am not

referring to palpation as part of your initial office visit/physical exam.)

 

In addition to the acupx/e-acupx codes, there are other procedure codes for

which we can be reimbursed. So, if you've done them, bill for them.

 

As for the E/M codes, as has been mentioned, you don't bill for one at each

visit as long as the treatment plan remains the same. It is typical to bill

an E/M code for the initial consultation. Subsequent visits are typically

procedure codes only. After 4-6 visits, it is typical to re-examine the

patient to check progress and make any changes to the treatment plan if

necessary - and as long as you've actually done this (meaning you've done a

physical exam, repeated any orthopedic exams that were abnormal, re-palpated

the area to compare to initial findings, etc.) then you can bill an E/M code

in addition to your procedure codes.

 

You may bill an E/M code if, during the course of a treatment, the patient

comes in for something not related to the existing treatment plan that

requires you to do an intake, exam, and tx plan (a new symptom, a new

injury, acute situation, etc.).

 

J

________

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

[Guest guest]

Joy,

 

The AMA link is not saying what you think it is on acupuncture treatment codes.

What is misleading here is that a practitioner must remain in " face-to-face

contact " with the patient as well as inserting another set of needles. That

does not mean put in needles and let them relax for the remainder of the time.

For billing a code of additional time one must insert an additional group of

needles, during their appropriate 15 minute time period. I have heard the time

aspect used to often suggesting that this is the only criteria that matters, it

isn't. I hope it is clear that we must meet time, contact and needle insertion

regulations in order to bill for additional time. In some ways, this is more

restrictive then what we previously did and more of a challenge for high volume

practices that bill insurance. All three criteria must be met in order to bill

for additional acupuncture treatment codes.

 

Samuel Collins is head of HJ Ross, and writes good articles on this for

Acupuncturetoday.com and also presents seminars on insurance billing for LAc's

and others. I would recommend his seminars as well as reading his articles

about billing. This is an important area for our profession to work upon.

 

Michael W. Bowser, DC, LAc

 

 

Chinese Medicine

JKellerLAc

Fri, 18 Sep 2009 10:57:05 -0700

Re: Insurance (U.S.A.) Billing Question

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With regards to the acupx codes - the information given so far

in this

 

thread is not accurate. The acupx codes are time-based, face-to-face

 

contact. The reference to " re-insertion " does not mean what most people in

 

our profession think it means. If you spend 45 minutes actively needling a

 

patient, then you bill 3 increments of 15 minutes (using the initial 15

 

minute acupx or e-acupx code, followed by one of the add'l 15 min acupx or

 

e-acupx codes).

 

 

 

It doesn't matter if you've only done " two " acupuncture procedures (meaning

 

a front and back tx). If it took you 30 minutes to do the front treatment

 

and 15 minutes to do the back treatment, that is 45 minutes of total active

 

needling, and that is how you bill the visit. This was clarified by the AMA

 

back in 2005.

 

 

 

The Medical Acupuncture Association website has had this clarification

 

posted for 4 years:

 

http://www.medicalacupuncture.org/cptassistant.pdf

 

 

 

Remember, that whatever you have to do while in the process of active

 

needling to be able to safely perform your treatment is considered part of

 

the active needling process. If, while needling, you have to palpate the

 

channel, that's part of the the active needling process. If, while needling,

 

you have to palpate for ah shi, or for the motor point, or for which

 

location is more tender, or where you want to cross-fiber needle the muscle,

 

etc...that's all part of active needling. If, while needling, you need to

 

check their pulse to see how your treatment is affecting the flow of energy

 

through the channels, that's part of active needling. (Note: I am not

 

referring to palpation as part of your initial office visit/physical exam.)

 

 

 

In addition to the acupx/e-acupx codes, there are other procedure codes for

 

which we can be reimbursed. So, if you've done them, bill for them.

 

 

 

As for the E/M codes, as has been mentioned, you don't bill for one at each

 

visit as long as the treatment plan remains the same. It is typical to bill

 

an E/M code for the initial consultation. Subsequent visits are typically

 

procedure codes only. After 4-6 visits, it is typical to re-examine the

 

patient to check progress and make any changes to the treatment plan if

 

necessary - and as long as you've actually done this (meaning you've done a

 

physical exam, repeated any orthopedic exams that were abnormal, re-palpated

 

the area to compare to initial findings, etc.) then you can bill an E/M code

 

in addition to your procedure codes.

 

 

 

You may bill an E/M code if, during the course of a treatment, the patient

 

comes in for something not related to the existing treatment plan that

 

requires you to do an intake, exam, and tx plan (a new symptom, a new

 

injury, acute situation, etc.).

 

 

 

J

 

________

 

Joy Keller, LAc, Dipl.OM

 

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

 

[Guest guest]

Possibly as important: Will you be in compliance to the FTC's RED FLAG

RULES by Nov. 1, 2009?

 

_http://www.ftc.gov/bcp/edu/pubs/articles/art11.shtm_

(http://www.ftc.gov/bcp/edu/pubs/articles/art11.shtm)

 

 

 

 

 

 

In a message dated 9/18/2009 5:50:06 P.M. Eastern Daylight Time,

JKellerLAc writes:

 

 

 

 

With regards to the acupx codes - the information given so far in this

thread is not accurate. The acupx codes are time-based, face-to-face

contact. The reference to " re-insertion " does not mean what most people in

our profession think it means. If you spend 45 minutes actively needling a

patient, then you bill 3 increments of 15 minutes (using the initial 15

minute acupx or e-acupx code, followed by one of the add'l 15 min acupx or

e-acupx codes).

 

It doesn't matter if you've only done " two " acupuncture procedures (meaning

a front and back tx). If it took you 30 minutes to do the front treatment

and 15 minutes to do the back treatment, that is 45 minutes of total active

needling, and that is how you bill the visit. This was clarified by the AMA

back in 2005.

 

The Medical Acupuncture Association website has had this clarification

posted for 4 years:

_http://www.medicalahttp://www.http://www.medichttp_

(http://www.medicalacupuncture.org/cptassistant.pdf)

 

Remember, that whatever you have to do while in the process of active

needling to be able to safely perform your treatment is considered part of

the active needling process. If, while needling, you have to palpate the

channel, that's part of the the active needling process. If, while

needling,

you have to palpate for ah shi, or for the motor point, or for which

location is more tender, or where you want to cross-fiber needle the mus

cle,

etc...that's all part of active needling. If, while needling, you need to

check their pulse to see how your treatment is affecting the flow of energy

through the channels, that's part of active needling. (Note: I am not

referring to palpation as part of your initial office visit/physical exam.)

 

In addition to the acupx/e-acupx codes, there are other procedure codes for

which we can be reimbursed. So, if you've done them, bill for them.

 

As for the E/M codes, as has been mentioned, you don't bill for one at each

visit as long as the treatment plan remains the same. It is typical to bill

an E/M code for the initial consultation. Subsequent visits are typically

procedure codes only. After 4-6 visits, it is typical to re-examine the

patient to check progress and make any changes to the treatment plan if

necessary - and as long as you've actually done this (meaning you've done a

physical exam, repeated any orthopedic exams that were abnormal,

re-palpated

the area to compare to initial findings, etc.) then you can bill an E/M

code

in addition to your procedure codes.

 

You may bill an E/M code if, during the course of a treatment, the patient

comes in for something not related to the existing treatment plan that

requires you to do an intake, exam, and tx plan (a new symptom, a new

injury, acute situation, etc.).

 

J

________

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

 

[Non-text portions of this message have been removed]

 

 

 

 

 

 

 

 

[Guest guest]

Thank you Angela, Mike and Joy for the input. Appreciate it. Nancy Corsaro,

L.Ac.

[Guest guest]

I think I was pretty clear in using the reference to " active needling " that

I was not in any way referring to time the patient spends alone relaxing

with the needles. Active needling means that I am still in the room,

face-to-face contact with the patient and in the act of performing the

acupuncture treatment (i.e., active needling does not refer to time spent

sitting down talking to the patient, charting, etc. or any other activity

not directly related to performing the treatment via acupuncture).

 

Of course I agree that each increment of 15 minutes must meet the time,

contact and needle insertion requirements - I'm not sure why you think I

stated otherwise. I believe the use of the phrase " active needling " meets

all three requirements.

 

It is inaccurate, however, to state that doing a front and back treatment is

linked to only using 2 increments of acupx codes because two " procedures "

were done. (And, yes, I have been to many acupx training seminars on

insurance billing and am familiar with the articles you suggested. I have

also worked with several medical billers who specialize in acupx practices -

one who is the president of the SoCal chapter of the American Medical

Billing Association.) I was trying to clarify that as long as you are in the

process of active needling, it doesn't matter if you did a front and a back

- it matters how long it took you to do that. In other words, that it is the

time spent in the process of active needling that determines how many

increments of acupx codes you bill, not whether you did a front and a back

treatment or not. As for this idea of " groups " of needles, I don't know

about you, but that is very easy to chart and it has nothing to do with

front vs. back.

 

Joy

 

On Fri, Sep 18, 2009 at 6:08 PM, mike Bowser <naturaldoc1wrote:

 

>

> Joy,

>

> The AMA link is not saying what you think it is on acupuncture treatment

> codes. What is misleading here is that a practitioner must remain in

> " face-to-face contact " with the patient as well as inserting another set of

> needles. That does not mean put in needles and let them relax for the

> remainder of the time.... [post trimmed]

>

>

 

 

 

[Guest guest]

Joy,

I agree with you that front vs back is not the issue but it appeared to me that

the issue of insertion/re-insertion was not clearly defined and appeared to

suggest that extra time is billable if it took you longer. If you do a

treatment on the front and then spend some additional time (let's say 30 more

minutes) on the back but only insert a single group of needles during the first

15 minutes on the back, you should not bill for the remaining 15. The reason is

that it is not a new group of needles per the cpt code definitions.

I also spent years working with medical billers and even analyzed/collected

insurance contracts for several HCA hospitals. My point is that if all three

criteria are not present, then it is not a legit usage of the cpt codes and can

put us at risk in the unlikely event of an audit. Active needling with

additional insertion beyond the prior 15 minutes would appear to fit the proper

coding definitions. The chart should reflect a group of needles separated from

other groups and have time noted as well. It is not hard to do but an important

task.

 

Michael W. Bowser, DC, LAc

 

 

 

 

 

Chinese Medicine

JKellerLAc

Sat, 19 Sep 2009 15:46:08 -0700

Re: Insurance (U.S.A.) Billing Question

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I think I was pretty clear in using the reference to " active

needling " that

 

I was not in any way referring to time the patient spends alone relaxing

 

with the needles. Active needling means that I am still in the room,

 

face-to-face contact with the patient and in the act of performing the

 

acupuncture treatment (i.e., active needling does not refer to time spent

 

sitting down talking to the patient, charting, etc. or any other activity

 

not directly related to performing the treatment via acupuncture).

 

 

 

Of course I agree that each increment of 15 minutes must meet the time,

 

contact and needle insertion requirements - I'm not sure why you think I

 

stated otherwise. I believe the use of the phrase " active needling " meets

 

all three requirements.

 

 

 

It is inaccurate, however, to state that doing a front and back treatment is

 

linked to only using 2 increments of acupx codes because two " procedures "

 

were done. (And, yes, I have been to many acupx training seminars on

 

insurance billing and am familiar with the articles you suggested. I have

 

also worked with several medical billers who specialize in acupx practices -

 

one who is the president of the SoCal chapter of the American Medical

 

Billing Association.) I was trying to clarify that as long as you are in the

 

process of active needling, it doesn't matter if you did a front and a back

 

- it matters how long it took you to do that. In other words, that it is the

 

time spent in the process of active needling that determines how many

 

increments of acupx codes you bill, not whether you did a front and a back

 

treatment or not. As for this idea of " groups " of needles, I don't know

 

about you, but that is very easy to chart and it has nothing to do with

 

front vs. back.

 

 

 

Joy

 

 

 

On Fri, Sep 18, 2009 at 6:08 PM, mike Bowser <naturaldoc1wrote:

 

 

 

>

 

> Joy,

 

>

 

> The AMA link is not saying what you think it is on acupuncture treatment

 

> codes. What is misleading here is that a practitioner must remain in

 

> " face-to-face contact " with the patient as well as inserting another set of

 

> needles. That does not mean put in needles and let them relax for the

 

> remainder of the time.... [post trimmed]

 

>

 

>