Best Practices: Coding for Acupuncture – Part 1

Since 1997, acupuncture codes that designate therapeutic procedures have been listed in Current Procedural Terminology (CPT®) (updated and published yearly by the American Medical Association). Diagnosis codes are listed in the International Classification of Disease, 10th Revision, commonly referred to as ICD-10.

The CPT® code set for acupuncture currently contains:

  • 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
  • 97811: Acupuncture, one or more needles, without electrical stimulation, each additional 15 minute increment of personal one-to-one contact with the patient, with reinsertion. (List separately in addition to code for primary procedure)
  • 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
  • 97814: Acupuncture, one or more needles, with electrical stimulation, each additional 15 minute increment of personal one-on-one contact with the patient, with reinsertion. (List separately in addition to code for primary procedure)

The CPT® codes are used nationwide and are the only HIPAA-compliant code set. Each code set goes through a process that includes definition of the code and valuation.

  • Creation – To create the acupuncture code set, the CPT Committee formed a workgroup comprised of representatives from the professional organizations that have acupuncture in their scopes of practice. These included the American Chiropractic Association (ACA), the American Academy of Medical Acupuncture (AAMA), the American Association of Oriental Medicine (AAOM) and the Acupuncture and Oriental Medicine Alliance (AOMAlliance). This group of practitioners met for over a year to develop a rational system that allowed for greater variability in coding an acupuncture treatment and was understandable to the CPT Committee – few of whom had any knowledge of acupuncture. Time-based codes are something that have many precedents in the framework of the CPT code set and the conclusion of the workgroup was that this was the best strategy for additional acupuncture codes. These codes were accepted by the CPT Committee and were then sent to the Reimbursement Update Committee (RUC) for valuation.
  • Definition – In the definition of the acupuncture codes the word “reinsertion” appears. As practicing acupuncturists know, needles are not re-used or points are not duplicated within a single treatment. This word was added by the AMA Reimbursement Update Committee to indicate an additional set of points that would demand a greater amount of work. A “set” is undefined but according to the code definition it could be a single point. It must, for documentation purposes, be distinctly separate in some fashion and in the process of code development it was implied that a set would require repositioning of the patient.
  • Valuation – Valuation of a code means establishing a number called a Relative Value Unit (RVU) for that code. The number of “Units” expresses a “Value” which is “Relative” to that of other procedures, whether they be a colonoscopy or a cold pack. The RVU is made up of three separate component values. The “work value” denotes the training, effort and intensity of the practitioner’s effort. The “malpractice value” denotes the risk involved in the procedure. The “practice expense value” denotes the cost of the office and equipment needed to perform the procedure. These three values are added to arrive at the RVU for that particular code. The RVU is then multiplied by a “conversion factor” to arrive at a dollar value for each code. The conversion factor is a dollar amount that is established contractually by insurers or regionally by CMS regulations for Medicare and Medicaid services. So, RVU x Conversion Factor = Reimbursement. The 2015 RVU for all CPT codes are available online here. You can determine your own conversion factor by dividing the dollar amount of your charge for a particular procedure by that procedure’s RVU.

In our next post, we’ll cover the RVU for acupuncture and discuss how the code set is used in an acupuncture practice.