I am having problems with coding acupuncture & E/M visits. I have a physician who is an MD. He performs acupuncture in his practice. We're struggling with when it's ok to bill a 99211-99215 with mod 25 AND the acupuncture. I have this note as an example. How would you code? Only acupuncture code? Or would you give a medical visit as well?

HERBAL FORMULAS: Relaxed Wanderer and Women’s Precious.

S: Her left shoulder pain is markedly less but it has been a little tight and sore the last day or so and stress is rather high at home and at work and we discussed this. The last treatment also really helped her ear pain. She had one flash of pain yesterday but that is all she has had all week. She has no headaches. She has a postnasal drip with some phlegm. No sore throat. No ocular problems. No dizziness. She is not bruising easily. No heart palpitations or breathing difficulties. Appetite is low and she craves salt. Upper GI tract, bowels and urination are normal. Energy is average. She has been waking up a lot but does fall back to sleep reasonably well. No excessive feelings of heat, cold or sweating. No abnormal thirst. She has lost 8 pounds on her diet. Uses no tobacco, drinks tea and has an occasional glass of wine. She drinks 4-6 glasses of water a day.

O: BP: 102/58. P: 72 and regular.

Both carotid pulses are stronger than the corresponding radial pulses.

ABDOMEN: Soft, no organomegaly nor masses. Tenderness below the umbilicus at the CV-4 and CV-5 zones clearly diminished on doing a sedation of TW-5 and tonification of GB-41. That test treatment normalized the pulses.

MUSCULOSKELETAL: Palpating the neck and shoulders shows a moderate amount of tenderness in the sternocleidomastoid and trapezius across the tops of the shoulders. The most tender trigger point is GB-21 midway on the superior border of the trapezius, right side greater than left and also GB-20, the root of the sternocleidomastoid and trapezius is tender.

Treatment focuses into the area where the patient has symptoms but is also constitutional based on the medical acupuncture evaluation and examination. KHT points are used bilaterally. Sedate TW-5; tonify GB-41, GB-34, Liv-3, pericardium 7, CV-4 and 5, GB-20 and GB-21.

A/P: The patient felt much more relaxed after the treatment and there was no pain. Continue current herbal formulas and followup in 4 weeks.

Thanks in advance.