Neurology & Pain Management Coding Alert

Question: We-re considering offering acupuncture services. We don't know whether carriers routinely reimburse for the service, though. Which codes would I submit for these services?

West Virginia Subscriber

Answer: Some payers have begun allowing coverage for some alternative medical treatments, including acupuncture, but Medicare continues to have a national noncoverage policy.

CPT includes four acupuncture codes:

- 97810 -- Acupuncture, one 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).

Heads up: Frequently, there are limitations regarding the number of sessions allowed and/or the conditions that support medical necessity for the treatment. For example, many carriers that do reimburse for acupuncture treatments don't reimburse acupuncture to treat chronic pain, fibromyalgia or other pain-related conditions. Check with your payer representatives to verify their policies.

Watch the clock: Acupuncture codes are time-based, so documentation should include the amount of time your provider spent in personal (face-to-face) contact with the patient -- even though this might not necessarily be the same amount of time as the duration of acupuncture needle placement.

Remember: If you do offer acupuncture services to Medicare patients, take note. Empire Medicare Services recently directed Indiana and Kentucky providers to start issuing Advance Beneficiary Notices (ABNs) when performing acupuncture procedures described by 97810-97814.

Reasoning: In its Medicare Monthly Review, Empire stated, "Previously, acupuncture was denied as a -noncovered- service. However, the correct denial for acupuncture is a medical necessity denial, and therefore, the physician must give the beneficiary an Advance Beneficiary Notice. Report modifier GA (Waiver of liability statement on file) with the procedure code to indicate that the patient signed an ABN." If the patient has not signed an ABN, append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the procedure code, Empire said.