Neurology & Pain Management Coding Alert

Medicare won't pay, but an ABN can save reimbursement If you're reporting acupuncture codes (97810-97814), make sure the documentation shows that the neurologist had one-on-one contact with the patient. And providers should not attempt to report acupuncture with and without electrical stimulation during the same session. Count the Minutes for Accurate Coding You should report acupuncture services based on the time the neurologist spends face-to-face with the patient. This differs from past coding, in which a single code unit equaled one "treatment."

For 2005, CPT introduced four new codes for acupuncture (and deleted previous codes 97780 and 97781):

97810 - 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 of needle(s) (list separately in addition to code for primary procedure)

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 needle(s) (list separately in addition to code for primary procedure). For the first quarter-hour the neurologist spends with the patient, report either 97810 (for services without electrical stimulation) or 97813 (for services with electrical stimulation). For each additional 15 minutes, report 97811 (to accompany 97810) or 97814 (to accompany 97813), says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

CPT does not limit the units of 97811/97814 you may report in addition to 97810/97813, but documentation must support all services you claim. Face-to-Face Doesn't Include Everything Be aware that "personal one-on-one contact with the patient" means the provider is not only in the room with the patient but actively performing a medically necessary component of acupuncture or electro-acupuncture, says Peter R. Martin, LAc, LMT, of Portland, Ore., a member of the Board of Trustees of the Oregon College of Oriental Medicine and of the Executive Committee of the Integrated Healthcare Policy Consortium.

Do not count the time that the neurologist leaves the needles in place as a portion of the "face-to-face" component, according to CPT guidelines.
 
Martin clarifies that personal one-on-one contact includes (but is not specifically limited to):
  selecting, locating, marking and cleaning the points
  washing your hands
  inserting and manipulating the needles, and
  removing and properly disposing of the needles. 
 
Example: The neurologist spends 15 minutes preparing the patient and placing needles for acupuncture without electrical stimulation. She leaves the needles in place for 20 minutes, removes the needles and repeats the procedure, again spending 15 minutes placing the needles and leaving them in place for 20 minutes.

In this case, you may [...]