Wiki Acupuncture CPT coding

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tbuxton

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I'm posting this here in General Discussion because I didn't see a sub-forum that seemed appropriate for Acupuncture.

CPT tells us that acupuncture is reported based upon 15-minute increments of personal (face-to-face) contact with the patient. There are codes for with and without electrical stimulation; for purposes of this question, let's forget about electrical stimulation and just use the following:

97810 - Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.

+ 97811 - [Acupuncture, 1 or more needles;] without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s).


Notice that the add-on code for each additional 15 minutes specifies with re-insertion of needle(s). My question is this: How do we code the service if there are more than 15 minutes of face-to-face time but no re-insertion of needles... that is, the initial set of needles are placed, and they are not moved, and no additional needles are introduced?

We cannot use code 97811, because it requires re-insertion of needle(s). We cannot use 97810 more than once. No other code seems applicable. The use of modifier 22 for extra work seems inappropriate here.

Any advice?

Thanks.
 
"Notice that the add-on code for each additional 15 minutes specifies with re-insertion of needle(s). My question is this: How do we code the service if there are more than 15 minutes of face-to-face time but no re-insertion of needles... that is, the initial set of needles are placed, and they are not moved, and no additional needles are introduced?"


I have the same question. Does anyone have any experience with this?
 
I believe I found the answer. I'm not familiar with this organization but I'm going to post it for a future reference.

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. 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.

http://acupuncturetoday.com/pdf_out...ing-Up-Confusion-Over-Code-Use-1300300778.pdf


Author's note: Special thanks to American Acupuncture Council for permitting the use of its specific coding examples.
 
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