ED Coding and Reimbursement Alert

Question: Our ED physician was asked by Dr. XX to see this patient and treat her for L wrist pain. Per patient, she was dx with L carpel tunnel syndrome two years ago and was given a splint which she does not wear. Over the last few days, the L wrist began to hurt and she last took pain meds last night. But the pain has persisted and she is not able to move her L wrist like her R. Pt is R handed, and she also types a lot. No allergies to any metal. 

Patient has heard of acupuncture but has never tried it. Mom has heard of acupuncture and both were enthusiastic about trying acupuncture instead of more NSAIDs which did not help with her pain. The physician explained to both mom and patient how he would administer the auricular acupuncture one needle at a time, and then would ask her how she feels before proceeding with additional needle insertion. Patient also agreed to have her interview and physical exam videotaped for educational and publication purposes. The consent is signed and witnessed.

Both ear lobes were cleaned with an alcohol prep pad. Then using Seirin J-type needles, the Battlefield Acupuncture Protocol was followed by first placing one needle on the L Cingulate point. After 2 minutes, patient reported that her pain went down from 8 out of 10, to 6-7 out of 10. A second needle was placed on the R Cingulate point. Two minutes later, patient reports that she felt that her pain was even more diminished down to a 6 out of 10. She felt that the L ear point gave her more pain relief. After walking around the room for another 2 minutes, patient accepted my offer to place a second needle on her L ear. The third needle was placed on the L Thalamus point. Within 2 minutes, patient stated that her pain was now zero out of 10. 

The L wrist’s range of motion was also much improved. At time of exam after the 3 needle placement, the L wrist ROM was in symmetry with FROM to the R normal wrist.  

Both patient and mother were happy with this therapy and pain relief. They also asked for a referral to an acupuncturist to continue as an outpatient. Patient was discharged by Dr. XX with a wrist splint to wear at night to avoid contortion while asleep. 

Answer: Although many payers follow CMS guidelines, which do not pay for acupuncture treatment in the ED setting, there are CPT® codes to describe the service in 15 minute increments. Since the chart notes do not mention that electrical stimulation was used, report the service using:  

97810 (Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient) 

This chart does not appear to meet the time threshold, but if you had exceeded the first 15 minutes by the required 7.5 minutes threshold you could use the add on code, +97811 (Acupuncture, one or more needles; 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]), to capture the additional time.

 If electrical stimulation had been used during the acupuncture treatment, codes 97813 and +97814 would be reported instead of 97810 and +97811.