Best Practices: Coding for Acupuncture – Part 2

In our last post (link) on this topic, we covered what the history of the acupuncture CPT® code set, what it comprises, and how the relative value unit (RVU) for a code is established, which brings us to the question: What is the RVU for acupuncture?

When CMS first published the values for 97810-97814 they ranged from .53 to .68. This was due to the cost of actually having an office being left out of the code value. Any use of those code values was a under-valuation of acupuncture services. Fortunately this error was corrected by CMS as of 2007. RVU for acupuncture as of 2015 are at:

Code 2015 RVU
97810 1.03
97811 .77
97813 1.10
97814 .87

The understanding of the original workgroup established by the CPT Committee was that the most common level of service would be 30 minutes of patient contact time, therefore, if there is no electrical stimulation, 97810 and one unit of 97811. If there is electrical stimulation one would use 97813 or 97814 or both as appropriate.

There are other nuances to code use. One of these is the aforementioned “reinsertion.” (See previous post.) Another involves evaluation and management (E&M) codes. E&M codes are divided into a new and a returning patient series with five levels of increasing complexity, time, and charge. New patient codes are 99201 through 99205. Established patient codes are 99211 through 99215. The difference between a new patient and an established patient is determined by time: if the patient has not been seen by anyone of the same specialty in your clinic within the past three years they can be considered “new.” Specific definitions of these codes can be found in the CPT manual. The 2015 E&M RVU are:

Code 2015 RVU Code 2015 RVU
99210 1.23 99211 .56
99202 2.10 99212 1.23
99203 3.05 99213 2.04
99204 4.64 99214 3.03
99205 5.83 99215 4.09

Typically within this model one patient encounter would entail the use of one E&M code and one or more procedure codes. The new codes for acupuncture do have a small amount of E&M included. The time element of the new codes are divided into three segments:

  • Pre-service: Greeting of the patient and a brief interval history. The code is based on this being 3 min.
  • Intra-service: Everything connected with doing the procedure – handwashing, positioning the patient, locating and cleaning the points, inserting and stimulating the needles, checking on the patient, removing the needles. The code is based on this being 15 minutes. This does not include needle retention time when the provider is not directly monitoring or communicating with the patient.
  • Post-service: Charting and any instructions to the patient. The code is based on this being three minutes.

If pre- and post-service time substantially exceeds 6 minutes the provider could charge for a suitable level of E&M, but it is essential to document that the requirements of that E&M code have been fulfilled per the CPT manual. The E&M code must also include a -25 modifier to denote that this is a significant, separately identifiable level of service. E&M codes are billed with a new patient and on reevaluation or a new diagnosis of an established patient. It is inappropriate to bill an E&M code on each visit for an individual patient. Additionally, everything the provider codes for must be supported in the clinical record.