Wiki E&M Bundled with Acupuncture Services?

[kosterweil]

Hi,

This is for an L.Ac. (non physician/chiropractor)

I need help. I bill acupuncture to NYS No Fault. For an initial visit we billed 99203-25 97810, 98711.

The 99203 was denied as part of the more comprehensive service?

This does not sound correct. It sounds like No Fault making up their own rules....

any insight/advice would be appreciated....

thanks!

 

[MikeEnos]

In order to bill an outpatient visit (99201-99215) alongside the acupuncture procedure (97810-97814), or any procedure for that matter, there needs to be a distinct, separately identifiable E&M service. The key factor here is going to be the purpose of the visit. All procedures have an Evaluation and Management component built-in, and it is figured in the pricing for the reimbursement. If the patient scheduled an appointment for acupuncture, and that's really all that was done, that's all that should be billed. However, if the appointment is scheduled to discuss treatment options, and acupuncture is agreed upon as the management option, then you can bill for an E/M service with the modifier -25 and then the procedure. Make sure that for the follow-up visits you make it clear whether they are coming back for another scheduled acupuncture treatment (in which case just acupuncture would be billed), or if they are back in the office for evaluation of their condition (just an office visit), or both. I hope I've made the distinction clear.

That is my experience as a coder - I can't necessarily tell you how each insurance will cover it, so from a billing standpoint there may be some alterations. I can tell you that Medicare lists the acupuncture codes 97810-97814 as a non-covered service. You may hae to call NYS No Fault to see if it is non-covered, see if you can add it to your contract, and/or see what their billing guidelines say.