Acupuncture is a traditional Chinese method for healing or relieving pain, and ranks as the 11th most popular complementary health approach. It is rapidly gaining acceptance in the United States. However, despite the increase in its adoption, most acupuncturists struggle with its billing, especially during CPT coding. Using accurate CPT codes is essential to collect reimbursements and maximize profits.
In this blog, we will cover the basics of CPT code 97810, discuss the related intricacies, offer tips on proper documentation, and share best practices to ensure you receive maximum reimbursements.
CPT Code 97810 – Description
Acupuncture is a type of complementary medicine used to treat a variety of physical and mental issues. In this process, the healthcare service provider inserts tiny needles into the skin at particular locations on the patient’s body.
CPT code 97810 reports this procedure. It represents the use of one or more needles, without electrical stimulation, for the first fifteen minutes of one-on-one patient interaction. During the session, the therapist manually punctures the skin and stimulates anatomical areas on or within the skin using solid, metallic, or fine, single-use needles.
This method helps in treating or preventing pain, postoperative and chemotherapy nausea and vomiting, stroke rehabilitation, asthma, addiction, and other diseases or disorders.
Scenarios Where CPT Code 97810 is Applicable
Below are some examples that further clarify the official description of CPT code 97810.
Chronic Lower Back Pain
Let’s begin by considering a 30-year-old client who visits an acupuncture clinic because of excruciating back pain. He claims that when he stooped to retrieve something from the ground, his back began to ache. The practitioner performs a fifteen-minute acupuncture session while placing needles in certain lower back regions without using electrical stimulation. Hence, she can bill these 15 minutes of services using the CPT code 97810.
Migraine
Imagine a 35-year-old woman who has been trying to find a way to stop getting migraines. Her friend suggests an alternative treatment from a licensed acupuncturist for her migraines. She visits a private practice for alternative therapy. The treatment session starts by placing needles in the meridian points of the hand, neck, and head, and leaving them there for 15 minutes. The entire procedure is carried out without the use of electroacupuncture, which involves transmitting electricity through needles. So, for these services, CPT code 97810 can be used.
Post-Chemotherapy Nausea
Suppose a 45-year-old woman undergoes chemotherapy for her breast cancer. She experiences severe nausea and vomiting post-therapy, and the prescribed medicines are of no help. She comes to your clinic and chooses to undergo acupuncture therapy to relieve nausea. You perform a fifteen-minute session without any electric current passing through the needles. To bill these 15 minutes of services, you can report CPT code 97810 on your claim.
Asthma
A 30-year-old woman with a history of mild chronic asthma often gets dyspnoea, especially as the seasons change. Despite using her specific medicines, she seeks complementary therapies to reduce the frequency of her symptoms and her dependence on medication. During a 15-minute treatment, a professional acupuncturist targets acupuncture sites commonly used for respiratory function. He can bill for his services using CPT code 97810.
Applicable Modifiers for CPT Code 97810
The following are the modifiers that may apply to CPT code 97810 in some cases.
Modifier 59
When you provide a service that is different or independent from a 15-minute acupuncture performed on the same day, you can apply this modifier to code 97810 to explain that needle piercing and manipulation are distinct and separately reimbursable from the first service.
Modifier GP
You can only apply this modifier if the acupuncture services are a part of a physical therapy care plan. This means that if any healthcare provider is curating a physical therapy plan for lower back pain, and they add acupuncture therapy to the plan, this modifier can be used to charge for the acupuncture services.
CPT Code 97810 – Billing & Reimbursement Guidelines
Read the following reimbursement guidelines carefully and implement them while billing with the CPT code 97810.
Provide Detailed Documentation
The first and foremost requirement for accurate reimbursement collection is documentation. If your paperwork is unclear or incomplete, you will inevitably receive a claim denial. You must document the following components while billing for CPT code 97810:
- The primary concern of the patient and any pertinent medical history.
- Information on the acupuncture treatment, such as the areas that were treated, how many needles were used, and any special methods that were employed.
- Total amount of time spent in person with the patient, divided into initial and subsequent increments.
- Referral from a physician or other healthcare professional.
Review Payer Policies
There is a common concern about whether insurance payers cover acupuncture services. Well, the answer is some may and some may not. Hence, you must enquire with the relevant insurance payers about coverage, including the number of treatments/sessions that the patient’s plan permits. However, in January of 2020, the Centers for Medicare and Medicaid Services (CMS) approved the use of acupuncture for chronic low back pain.
Frequency Limitation
With the coverage of acupuncture services, Medicare does apply some limitations on the session frequency. Medicare enrollees who fulfil the requirements can receive 12 acupuncture sessions within 90 days. For patients who show improvement, an extra eight sessions will be covered. However, no more than 20 acupuncture treatments may be given yearly. If you cross this limit, Medicare will not be responsible for extra sessions.
Summary
To summarize our guide, CPT code 97810 is only used for the first fifteen minutes of an acupuncture session. The healthcare provider must perform this session without any electrical stimulation and ensure one-on-one engagement with the patient.
This blog discusses various uses of this therapy. For example, back pain, post-chemotherapy nausea, headaches, and asthma may all be cured with a 15-minute acupuncture session. Furthermore, we have highlighted modifier 59 and GP, which can be used in some cases for coding specificity and accurate reimbursement collection.
However, despite this thorough guide, if you are still facing issues while billing for CPT code 97810, you can hire specialized acupuncture billing services. These services will help you with billing and managing claim denials.
