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Conflicting info about whether 97814 can be billed for extra time alone

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amykey86

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I had thought the add on codes 97814 and 97811 were for extra time in general, but now I'm finding information that says they can NOT be used for patient time spent lying on a table with no provider interaction. Which makes sense. But I keep seeing other info, including on this forum, saying to use them for addtional time beyond the 15 minutes. I can't seem to find any specific articles that address this as guidelines, just things advising people how to bill. Does anyone have a link they can share that addresses this as a rule? Thanks
 
The information is the CPT book. Go to the CPT book, go to the Acupuncture section and read right before the codes start. "Acupuncture is reported based on 15-minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement.

The CPT code descriptions individually state this again: "personal one-on-one contact with the patient"


Note "official" but just info: https://acupuncturetoday.com/article/30032-new-cpt-codes-for-acupuncture-are-here
What Does "15 Minutes" Mean?
"It is very important to note that "15 minutes" is defined as "personal one-on-one contact with the patient." This means that you are not only in the room with the patient, you are actively performing a medically necessary activity that is a component of acupuncture or electroacupuncture. The time that the needles are retained is specifically excluded for reimbursement. "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. We don't get paid for counseling under these codes. We don't get paid for evaluation and management of the patient under these codes, except for the "usual pre-service and post-service work associated with the acupuncture services." These codes are for performing the procedures of acupuncture or electroacupuncture, not for the initial history and exam or subsequent re-examination (more on this later). You can think of this as the time your hands are doing some component of the acupuncture service."

 
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