Neurology & Pain Management Coding Alert

For the first quarter-hour the neurologist spends with the patient, report either 97810 (for services without electrical stimulation) or 97813 (for services with electrical stimulation). For each additional 15 minutes, report 97811 (to accompany 97810) or 97814 (to accompany 97813), says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

CPT does not limit the units of 97811/97814 you may report in addition to 97810/97813, but documentation must support all services you claim.

Face-to-Face Doesn't Include Everything

Be aware that "personal one-on-one contact with the patient" means the provider is not only in the room with the patient but actively performing a medically necessary component of acupuncture or electro-acupuncture, says Peter R. Martin, LAc, LMT, of Portland, Ore., a member of the Board of Trustees of the Oregon College of Oriental Medicine and of the Executive Committee of the Integrated Healthcare Policy Consortium.

Do not count the time that the neurologist leaves the needles in place as a portion of the "face-to-face" component, according to CPT guidelines.
 
Martin clarifies that personal one-on-one contact includes (but is not specifically limited to):
 

The term "reinsertion of needles" in the descriptors of 97811/97814 doesn't mean that the neurologist inserts the previously positioned needle(s) again.
 
Rather, the phrase means that the practitioner treats a second group of acupuncture points. In other words, the neurologist repeats the process of washing hands, positioning the patient, cleaning the skin, inserting sterile needles, etc., Martin says.

Don't Report With/Without Stimulation Separately

CPT guidelines do not allow you to report acupuncture without electrical stimulation and acupuncture with electrical stimulation during the same session.

"The Reimbursement Update Committee's [which determines code values] thinking on this is to prevent acupuncturists from charging for inserting the needles (acupuncture) and then attaching electrodes to those same needles for the electrical stimulation, thus billing twice for inserting the same needles," Martin says.

Therefore, if the neurologist administers electrical stimulation during any portion of the service, you should report the entire service using the codes for acupuncture with electrical stimulation (97813/97814)

Example: The neurologist provides 15 minutes of electrical stimulation followed by needle reinsertion and 15 minutes of acupuncture without electrical stimulation. You should report 97813, 97814 (not 97813, 97811), even though the neurologist did not provide electrical stimulation during the second 15 minutes.

Use an ABN to Provide Reimbursement

Medicare carriers are still failing to reimburse for acupuncture - even with the introduction of new codes - which means you'll probably have to bill patients directly for the service.
  
For 2005, CMS assigned 97810-97814 a payment status "C," meaning that individual payers are free to price the codes as they see fit. In practice, this means that local payers may not pay for the codes at all.
 
Although many regional payers have not yet developed local coverage determinations (LCDs) for the new acupuncture codes, several others have already decided to withhold reimbursement.
 
If you wish to receive payment for acupuncture, you should ask the patient to sign an advance beneficiary notice (ABN).

The proper time to have the patient sign an ABN is before providing the service or procedure for which you want to recoup payment, says Jeff Fulkerson, BA, CPC, CMC, certified coder at The Emory Clinic.

After you've secured a signed ABN from the patient, you must inform Medicare by appending modifier -GA (Waiver of liability statement on file) to any acupuncture service codes you provide.

When Medicare sees modifier -GA, it will send an explanation of benefits to the patient confirming that he is responsible for payment. If you don't append the modifier, Medicare will not inform the patient of his responsibility.