Anesthesia Coding Alert

Question: Our facility is considering offering acupuncture services. Do carriers routinely reimburse for the service? Which codes would I submit for these type
of treatments?
West Virginia Subscriber

Answer: Some payers allow coverage for some alternative medical treatments, including acupuncture, but Medicare continues to have a national noncoverage policy for acupuncture.
CPT includes four acupuncture codes:

• 97810 -- Acupuncture, 1 or more needles; without   electrical stimulation, initial 15 minutes of personal    one-on-one contact with the patient
• +97811 -- ... without electrical stimulation, each    additional 15 minutes of personal one-on-one contact  with the patient, with re-insertion of needle(s) (list separately in addition to code for primary procedure)
• 97813 -- ... with electrical stimulation, initial 15    minutes of personal one-on-one contact with the patient
• +97814 -- ... with electrical stimulation, each    additional 15 minutes of personal one-on-one contact  with the patient, with re-insertion of needle(s) (list separately in addition to code for primary     procedure).

Keep time: Acupuncture codes are time-based, so your documentation should include the amount of time your provider spent in personal (face-to-face) contact with the patient. Coding for acupuncture services is based on the face-to-face time, which might not be the same amount of time as the duration of acupuncture needle placement.

FYI: Unlike many add-on codes that have only one primary code, CPT parenthetical notes state that providers can use +97811 and +97814 with both 97810 and 97813. Also note that the CPT section guidelines clearly tell you that you may use only 97810 or 97813 for the initial 15-minute increment. You may report only one of these primary codes per day.

Watch out: Payers may limit the number of sessions allowed or may limit the conditions that support medical necessity for the treatment. For example, some carriers that do reimburse for acupuncture treatments don't reimburse acupuncture to treat carpal tunnel syndrome, fibromyalgia, neuropathies, or tennis elbow. Consumers' interest in complimentary and alternative medicine coverage, such as acupuncture, is prompting more insurance companies and managed care organizations to consider offering this coverage as an alternative treatment option. It is best to check with your payer representatives to verify their policies.