We Get Letters & E-Mail -- From the May 2005 Issue of Acupuncture Today
By Editorial Staff
An Open Letter to the AAOM and the AAC Insurance Task Force
After reading the article in the March 2005 issue of Acupuncture Today regarding the three-tier additional coverage and the Q & A addendum from the AAOM, I was encouraged for our profession that an open discussion was taking place on such an important topic.
However, the ambiguity of the terms found in the article raises many questions regarding such a proposed expansion of malpractice coverage.
As a member of the AAOM, a policy holder with the American Acupuncture Council (AAC), and a regular reader of Acupuncture Today, I would like to see the following items appear in a future policy for malpractice insurance for acupuncturists:
1) Clarification of what TCM/OM practices qualify as gynecology, if the term gynecology is to remain as a listed exclusion; 2) Inclusion of TCM/OM techniques used to treat any condition/symptom related to a non-pregnant woman's menstrual cycle as part of the basic malpractice coverage that AAC offers; and 3) Clarification of what the AAC considers as "Western-style gynecology or the delivery of children..." (e.g., Is the delivery of the placenta covered in tier three? What about using TCM to alleviate uterine bleeding or cramping?).
The phrase "some Western medical gynecology techniques" is vague and misleading. As practitioners, we are trained to treat gynecological conditions such as irregular/painful menstruation by using traditional Chinese medicine/Oriental medicine. As far as I am aware, OM colleges are not teaching their students "Western medical gynecology techniques" for the treatment of any health condition. Furthermore, it is not within the scope of practice for acupuncturists to practice gynecology or the delivery of children.
The terms gynecology, obstetrics, and Western medical gynecology techniques need to be clarified, and they need to reflect what is within the scope of practice for acupuncturists. If I treat pregnant women for back pain, I am not practicing obstetrics or managing their pregnancy. If I treat women to enhance their fertility, I am not practicing gynecology.
Women who seek treatment for conditions related to their reproductive cycle respond amazingly well to acupuncture and OM. Acupuncture is a safe and affordable medicine. Exclusions of malpractice policies have hindered OM practitioners for fear of financial losses. Additional coverage is ideal. My hope is that an expansion of malpractice insurance coverage would simultaneously allow greater autonomy and maintain affordability for practitioners.
Thank you for taking my suggestions into consideration.
Chia Chia Cheng, LAc Portland, Oregon
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New CPT Codes Are Affecting Insurance Reimbursement
As an acupuncturist and office manager of a four-practitioner office, I am frustrated and angry at the reduction in reimbursement that we are seeing from insurance companies. Our reimbursement has been reduced by approximately 39 percent! We provide the same service, the same integrity, and the same level of care and compassion, now valued at 39 percent less. I am furious and resentful of these changes.
I have been practicing acupuncture since 1980. The direction these new codes have taken us financially does not feel at all forward or positive. Is there any forum for practitioners to use our collective power to challenge this regressive direction? Please let me know.
Peter Kadar, CA, Dipl. Ac. Morristown, New Jersey
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"Knowing and Understanding the CPT Codes ... Is Essential to Successfully Submitting a Claim"
Thank you for the article, "AIMS Conducts Analysis of New CPT Codes." I was beginning to wonder if I was the only person who questioned the explanation for the new CPT codes and the appropriate way to use them. I appreciate the fact that AIMS is questioning the wording of the new CPT codes and the appropriate application thereof.
One aspect of David Wells' commentary that was not addressed in the AIMS article was the statement that "personal one-on-one contact with the patient does not mean hanging out with the patient and talking about their five-element preferences, or their love life, for that matter." Granted, while every school teaches the fine art of diagnosing a patient in different ways, discussing the patient's five-element preferences and their love life are both appropriate ways to gather information to help the practitioner refine their diagnosis and further complement their effectiveness in treating the patient successfully. After all, this is traditional Chinese medicine we are practicing, not some Western medicine permutation, randomly inserting needles.
Another area of the CPT code knowledge and application is being totally ignored in these articles. Dr. Wells comments that the evaluation and management service for the patient is implied to be included in the CPT codes for acupuncture. There are separate CPT codes for evaluation and management, which can be appropriately applied to any insurance bill. These codes are 99203-99205 for new patient evaluation and management, and 99213-99215 for established patient evaluation and management. Check with your CPT codebook for the specific definition and requirement for the correct application of these CPT codes.
I teach a class in insurance billing for alternative medicine, and can assure you that knowing and understanding the CPT codes is one of the areas of knowledge that is essential to successfully submitting a claim. I would be more than happy to participate in the necessary actions to refine the CPT codes.