| A year-and-a-half after inviting acupuncturists to participate in a special CPT advisory sub-committee, the AMA has released its new 2005 CPT codes, which include a change to acupuncture and electroacupuncture codes. |
| The following information has been cut and pasted directly from the AMA's CPT® 2005 website: |
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Acupuncture |
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97810 Acupuncture, one or more needles, without electrical stimulation; initial 15 minutes of |
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personal one-on-one contact with the patient |
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97811 each additional 15 minutes of personal one-on-one contact with the patient |
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(List separately in addition to code for primary procedure) |
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(Use 97811 in conjunction with 97810) |
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(Do not report 97810, 97811 in conjunction with 97813 or 97814) |
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(Evaluation and Management services may be reported separately, using the modifier 25, if the patient’s condition requires a significant separately identifiable E/M service, above and beyond the usual preservice and postservice work associated with the acupuncture services. The time of the E/M service is not included in the time of the acupuncture service.) |
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97813 Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes of personal |
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one-on-one contact with the patient |
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97814 each additional 15 minutes of personal one-on-one contact with the patient |
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(List separately in addition to code for primary procedure) |
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| We have yet to receive a hard copy, and so do not know if 97812 and 97815 are reserved for "unattended" acupuncture and electroacupuncture. That would be important, as dividing current single billing code and fee into two or more billing codes and fees should not change the fees being currently charged for treatment. However, complicated or time-consuming cases could theoretically be charged more, and simple cases to be charged less. |
| 97810 and 97813 (preparation, insertion, and initial manipulation) are likely to be more heavily weighted in fee schedules than 97811 and 97814 (final manipulation and needle removal), but by how much is incertain. For example, if someone is currently charging $100 per electroacupuncture treatment, they might consider charging $70 for the first fifteen minutes (97813) required to insert the needles, manipulate the needles, connect the electrostim device, and adjust the electrostim. and $30 for the last fifteen minutes (97814) required to shut off and detach the electrostim, and remove the needles. Or, they might charge $60/$40 or $50/$50, since no relative ratings have been suggested or established at this time. |
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| As stated in the CPT, first patient visits that require a history, examination, and diagnosis would be billed under an E/M codes 99201-99205 (using the modifier -25 for when treatment is also provided on the same date), which is the usual and customary procedure for most acupuncturists. |
| The "usual preservice and postservice work associated with the acupuncture services" referenced in the codes should be understood to mean the routine brief re-exam and re-assessment of a patient's response to the previous treatment, minor modifications to the treatment, and hygienic protocol, insertion, electrostim adjustment, removal of clips and needles, chart and progress notes, etc. |
| It would not include a thorough re-examination and re-assessment that resulted in significant findings or changes, and that would be billable under E/M codes 99211-99215. |
| It is important that our profession define the meaning of any terms that are vague or undefined. |