Q: I am confused with the codes for billing acupuncture services. When I do a treatment of acupuncture, I routinely allow the needles to stay in the patient for approximately 30 minutes.
During the 30 minutes, I may manipulate the needles two to three times. Considering there is a total of 30 minutes, is it proper to bill 97810 for the first 15 minutes and one unit of 97811 for an additional 15 minutes, considering the total time of 30 minutes?
A: I will answer the question directly first. No, you may not bill 97811; the only code for what you described is 97810. I understand there has been some confusion as to the use of the codes for acupuncture that has lingered since they changed in 2005. Let's try to clear it up. Acupuncture has four codes to describe specific acupuncture services.
Acupuncture, one or more needles, without electrical stimulation; initial 15 minutes of personal one-on-one contact with patient.
Without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient with re-insertion of needle(s). (List separately in addition to code for primary procedure.)
Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes of personal one-on-one contact with patient.
With electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient with re-insertion of needle(s). (List separately in addition to code for primary procedure.)
While it may appear that each 15 minutes of additional time spent would qualify for the added time, this is an incorrect assumption. The add-on codes of 97811 or 97814 actually are better understood by realizing they are to be used to indicate a new set-up or set of needles being applied, not the time the needles are retained. A simple example is a patient who is prone while undergoing an acupuncture needling session, and after the needle set-up is completed, the needles are retained with the patient for 20 minutes. Then, those needles are removed, the patient is repositioned and another set of needles is used. This added set or new set of needles is then billed with the code of 97811 or 97814.
Here is an example of billing 97810 and 97813: The practitioner reviews the chart and obtains a review of the chief complaint, changes since the last visit and a review of systems if relevant. A brief physical examination of the area involved in the diagnosis is done. Assessment of the changes since the last visit and evaluation of overall treatment effectiveness are documented. Acupuncture points are selected for the day's treatment. The patient is positioned and the points are located, marked and cleaned with alcohol. The proper needle gauges and length are selected, and following hand-washing, the needles are inserted. The patient is given instruction to rest with the needles remaining in place for 20 minutes.
The procedure is charted, and the practitioner may leave the patient while the needles are retained. The practitioner will periodically monitor the patient and may stimulate or re-stimulate the needles. Once the desired effect is reached, the practitioner will remove the needles and will press the points with cotton balls to prevent bleeding or bruising. The needles are then disposed of in accordance with Occupational Safety and Health Administration (OSHA) guidelines.
The practitioner will then assess the treatment given and assist the patient to an upright position. Any additional chart notations would also be done at this time. When the acupuncture needles are stimulated with electricity, the code to be used is 97813. All other aspects of billing 97813 are done per the chart above. Note that the time of the needles being retained does not influence the coding.
Here is an example of billing 97811 and 97814: Following the initial 20-minute session of acupuncture, the needles are removed and the patient repositioned. New points are selected to complete the treatment; then they are marked and cleaned with alcohol swabs. Needles are inserted and manipulated to obtain the desired therapeutic effect. The patient is instructed to rest for 20 minutes as the needles are retained. The practitioner returns to monitor the patient and may further manipulate the needles. When the treatment is complete, the practitioner removes the needles and places pressure on the points with a cotton ball to prevent bleeding or bruising. The needles are disposed of in accordance with OSHA guidelines. The patient is helped to an upright position and given follow-up instructions. Final documentation is recorded in the patient chart. (When the acupuncture needles are stimulated with electricity, the code to be used is 97814. All other aspects of billing 97814 should be done per the chart above.)
The driving factor of the additional coding is the necessity of using an additional set-up of needles. Should a third or fourth set-up be required, then certainly, codes 97811 and 97814 may be billed for multiple units, equivalent to the number of set-ups.
Author's note: Special thanks to American Acupuncture Council for permitting the use of its specific coding examples.
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