Your acupuncture session with electrical stimulation was longer than the standard 15 minutes? Report the extra time with CPT code 97814. Acupuncture billing may seem simple with only a handful of codes. However, billing mistakes are common in this field. Healthcare providers often pair the wrong CPT codes with their treatment.
It is mainly due to a lack of proper documentation about the session, including a missing duration. So, what are the billing requirements for this add-on code? You can find all the essential information about the 97814 CPT code in this blog.
CPT Code 97814 – Description
As we briefly discussed in the intro, CPT code 97814 is an add-on code. It is mainly reported with CPT code 97813 to indicate that an acupuncturist spent more than 15 minutes on stimulating a patient’s nerves.
To be more specific, this code represents additional time beyond the first 15 minutes of a one-on-one acupuncture session in 15-minute intervals. Hence, you can use it to bill for the additional patient contact after the initial primary service.
Scenarios Where CPT Code 97814 is Applicable
To understand this acupuncture add-on code better, you can explore the following three scenarios:
Reporting Additional Time Spent on Treating CLBP
Did you know that the American College of Physicians recommends acupuncture as the first line of care for chronic low back pain (CLBP)? It is especially beneficial for improving several CLBP’s disabling effects in older adults, including insomnia and emotional symptoms.
So, for the first scenario, suppose a 45-year-old woman with degenerative disk disease suffers from this type of pain. The pain usually worsens with movement, especially bending or lifting something. After trying and failing to find some relief through medication and physical therapy, she visits an acupuncture clinic.
The acupuncturist inserts more than one needle in the local points of her lower back and uses a mild electrical current to stimulate her nerves for 31 minutes. After this session, the provider bills the initial 15 minutes with a primary code and the additional time with CPT code 97814.
Billing a 45-minute-long Electro-Acupuncture Session
Patients involved in car accidents often suffer from unexpected problems, including foot drop injuries. We all know how foot drop is generally a sign of an underlying nerve issue. Therefore, it can often be treated with acupuncture in such cases.
Since men are generally more involved in car accidents, let’s consider a 21-year-old who damaged his leg in one such incident. He develops a drop foot due to severely damaged nerves in his knee. After being in rehab for some time without any improvement, he finally gives acupuncture a try.
During a one-on-one session, an acupuncturist uses electro-acupuncture to stimulate the nervous system to promote healing. The session is longer than 45 minutes. Hence, the provider adds two units of CPT code 97814 to the primary code.
Longer Electro-Acupuncture Session to Treat a Medicine-Resistant Chronic Migraine
For the last example, let’s use the medicine-resistant migraine example we discussed for 97814’s primary code. The 37-year-old woman visits an acupuncture clinic after experiencing more frequent attacks.
The acupuncturist examines her condition, takes her history, and learns her usual symptoms, including a throbbing pain on the left side of her head. He then places several thin needles on specific pressure points and applies electrical pulses to reduce her pain. His billing team then bills for this 33-minute session with a combination of CPT codes 97813 and 97814.
CPT Code 97814 – Billing & Reimbursement Guidelines
So, which requirements should you fulfill for this add-on code? Simply explore our billing and reimbursement guidelines for CPT code 97814 to find the answers.
Use CPT Code 97814 with 97813
As we have mentioned quite a lot of times in this blog, the 97814 CPT code is an add-on code. Hence, you cannot report it separately. Since it indicates additional time after the initial electro-acupuncture service, always use it in conjunction with CPT code 97813. Otherwise, every payer will automatically deny your claim.
Report Additional Time in 15-Minute Intervals
Your coding must meet the time requirements. Remember that CPT code 97814 indicates an additional 15 minutes beyond the first 15. Hence, use it only to bill for continuous electro-acupuncture service. You can use this code in 15-minute intervals. For example, if the session lasted an hour, use CPT code 97813 to bill for the first quarter and the remaining three quarters with three units of 97814.
Thoroughly Document the Electro-Acupuncture Session
Your documentation for this service must also include the justification for a longer session. For complete reimbursement, you must record the following details:
- Patient’s condition
- Reason for acupuncture with electrical stimulation
- Number of needles and their placement
- Duration of the session (start and stop times)
- Treatment response
Avoid Using Modifiers
You know the common rule! CPT code 97814 is an add-on code. Hence, you cannot apply any modifier to it. For communicating additional information, use modifiers with the primary code of this service, CPT code 97813.
Summary
Did we lay down all the basics of CPT code 97814? We hope our blog helped you understand this electro-acupuncture add-on code. To summarize, the 97814 CPT code is quite useful in reporting all extra time beyond the first 15 minutes of a face-to-face acupuncture session.
Healthcare providers often use this code with CPT code 97813 to notify payers about each additional 15 minutes spent on a patient. In short, using this code is quite simple, as you can see from this guide. But if you still need an expert’s touch, you can opt for our acupuncture billing services.
