Every medical biller is aware of the importance of accurate coding for proper reimbursement. What happens if the healthcare provider has provided primary services, but the patient requires additional services? How will you bill this extra service? For these services, there are add-on codes. To put it simply, an add-on code is another billing code used with the primary code to indicate extra time or services.
This blog discusses one of the add-on codes for acupuncture services. By the end of this read, you will be clear about the difference between CPT codes 97811 and 97810. You will also find key billing guidelines to ensure correct claim submission and reduced denials. Read further to understand the intricacies of this code.
CPT Code 97811 – Description
CPT code 97811 is an add-on code. It is used with the primary code, 97810, which represents the acupuncture treatment for the initial 15 minutes without electrical stimulation. On the other hand, CPT code 97811 addresses the extra fifteen minutes following the original procedure.
The provider uses one or more needles to puncture the skin without any electrical stimulation. He manually manipulates the needles to stimulate anatomical locations on or in the skin. Following the initial manual acupuncture therapy, this service covers each extra fifteen minutes of patient interaction.
Scenarios Where CPT Code 97811 is Applicable
The following are some practical situations where acupuncture services can be used and reported with the CPT code 97811.
Stress Treatment
Suppose a 30-year-old woman struggles with stress a lot. She cannot find a way to manage it. She has tried various techniques such as yoga, meeting with friends, and journaling, yet she finds it difficult to deal with stressful situations. She finally decides to try acupuncture services to regulate stress hormones like cortisol and endorphins.
The service provider carries out an acupuncture therapy on her for the initial 15 minutes. But her condition needed an extra 15 minutes of therapy to relax her brain and influence the nervous system. So, the service provider performs an additional 15 minutes of manual acupuncture. Hence, he can charge these extra 15 minutes of service with CPT code 97811.
Migraine Reduction
Imagine a 25-year-old man who has been suffering from migraine since his teenage years. His condition is so severe that no medication is curing or reducing the intensity of his migraine. So he finally gave up on medication and decided to take acupuncture therapy.
The acupuncturist continues the process of inserting needles for more than 15 minutes. Therefore, he can charge the initial 15 minutes with the primary code and additional time with an add-on CPT code 97811.
Dysmenorrhea Treatment
Suppose a young woman visits your acupuncture clinic with severe menstrual cramps (dysmenorrhea) that usually start a day before her actual date and continue for the next 48 hours.
Hence, she decides to try the acupuncture service as an alternative treatment for pain management. The service provider carries out the procedure for more than the initial 15 minutes. In this case, he must bill his extra services with CPT code 97811.
Muscle Tension Reduction
Let’s say a 19-year-old young man who just started going to the gym performs an exercise with improper technique. This results in tight and immobile muscles. To ease his tense muscles, he sees an acupuncturist. The service provider inserts needles into the desired location without electric stimulation. He carries out the procedure for more than fifteen minutes. So, he will use the add-on CPT code 97811 to bill for those additional minutes.
Applicable Modifiers for CPT Code 97811
Did you know that add-on codes typically don’t require modifiers? Why? Because the modifiers are appended to the primary code. Applying modifiers to both the primary and add-on codes would result in unnecessary repetition since add-on codes are always used in conjunction with the primary codes. Therefore, modifiers should not be applied to CPT code 97811 since it is considered an add-on code.
CPT Code 97811 – Billing & Reimbursement Guidelines
You must adhere to these reimbursement rules for CPT code 97811 to receive accurate payment for your services.
Meet the Documentation Requirements
Documentation is the primary prerequisite for precise reimbursement collection. Your claim will undoubtedly be denied if your documentation is confusing or lacks authenticity. You must provide an appropriate diagnosis code and a justification for the additional 15 minutes of service you provided (as you are billing for extra services under CPT code 97811) in addition to completing and submitting other required documentation.
File the Correct Code
It is essential to file your claims with an accurate code that appropriately represents the service performed. If you are not reporting an additional service with its respective code, or you are reporting an extra 15 minutes with the modifier for increased services, then you are doing it wrong. There is a clear chance of claim rejection.
Therefore, it is vital that you ensure coding accuracy and specificity when submitting claims for your acupuncture services. Here is a brief coding guide:
- CPT Code 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes.
- CPT Code 97811: Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes.
- CPT Code 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes.
- CPT Code 97814: Acupuncture, one or more needles, with electrical stimulation, each additional 15 minutes.
Do Not Append a Modifier
As we previously stated, using modifiers with add-on codes would be incorrect. Modifiers applied to add-on codes can be redundant or even lead to incorrect payment.
Review Payer Policies
Some insurance payers (including Medicare) do not cover acupuncture services in their payment plans. Therefore, you should review the policies and procedures of an insurance payer before submitting your claims. This action can prevent unnecessary rejections.
Conclusion
In conclusion, you can only use CPT code 97811 for an extra fifteen minutes of manual acupuncture therapy, and only after the first procedure is finished. We have discussed various useful applications of this code in our blog, such as an additional 15 minutes of acupuncture therapy for managing stress, easing muscle stiffness, and treating menstrual discomfort.
However, since this is an add-on code, you should not apply any modifiers to it. We also briefly discussed a few billing tips, which may help you avoid claim denials.After reading this comprehensive guide, if you are still having trouble charging for services covered under CPT code 97811, you may turn to expert acupuncture billing services. These can streamline your billing, ensure clean and compliant submissions, and reduce denials for optimal revenue collection.
