Prevent Claim Denials- Document Acupuncture Properly



So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone. This is Sam Collins, the coding and billing expert for acupuncture, your Advocate, and I’m part of the American Acupuncture Council, specifically the network. We’re always here to help. We’re always here to help make sure your practice is better, and that’s what the American Acupuncture Council is about.

We wanna make sure that your practice continues to thrive and prosper. 2023 is right here, and one of the questions I get as the coding and billing expert is, how do I document acupuncture? And this has been an ongoing issue for many acupuncturists because of course, unfortunately there is a lot of bad information that’s out there as to what you’re gonna require to do.

So I wanna give you a short primer on what you must do in order to make sure the documentation you are using meets the standard to make sure you get paid. And more importantly, making sure the patients has documentation of the services they received and the outcome. So without further ado, let’s get started.

Let’s go ahead and get to the slides. Let’s talk about documenting acupuncture for compliance, for accuracy, but ultimately payment. Let’s make sure you’re getting paid for what you do. And of course, prevent denials. Now, I’m not gonna be too worried about denials if we do the right types of things. So let’s talk about documentation generically.

Documentation is such that an acupuncture should maintain accurate and complete records. It’s what we do for our patients. Forget insurance or anything else. We have to reflect what was done to assure that what was done was compliant and protects us as well. We should ensure that they’re C correct also, to make sure we’re getting the proper payment for services and we can support that.

Good documentation practices also assures that your patients receive the appropriate care from you as well as it becomes the record for future. If they have to have go to another provider, they can make sure it’s there, realize it’s part of their permanent legal record that we’re required to keep. And I’m not saying it has to be fancy.

but it has to adequately meet the needs of what we do as acupuncturists or what you do. I’m just your advocate. So the few things that I’m gonna focus in on today is gonna be acupuncture, but I wanna highlight all the things. E and m services or exams should reflect the level of service that you’ve provided and it wouldn’t match the code.

or price that you build? Of course the acupuncture itself must reflect the time and the points, and this is what we’re gonna focus on. There’s often a lot of misunderstanding on what is required for documentation or acupuncture. We’re gonna clear that up. And then if you’re doing any therapies, let’s make sure that the therapies are identified specifically where they’re being applied by example.

You just don’t wanna check off, I did infrared heat, but tell me where you. for how many minutes? So we know what the intensity and time, so we know comparatively how we do it the next time. So we have to make sure that in a way that if someone were to read what we’ve done, They know what we’ve done. They wouldn’t have to guess by just checking I did acupuncture.

They would know where did we do it? What were the points? How much time did we spend? And these are the problems I run into as the coding and billing expert. I’m contacted by state boards, department of Defense, meaning the va. The wa Hoag, world Health Organization and almost every carrier out there, including malpractice carriers that deal with documentation issues.

So I wanna give you the definitive way of making sure this is correct. You’ll notice here, this is a denial if you’re not familiar from the company, UnitedHealthcare, and it quite frankly, is a very good pair of acupuncture. And you’ll notice it indicates. The information submitted does not contain sufficient detail to support the services.

So what is it that they’re missing? And you’ll notice they’re missing it on the initial set. And the follow-up sets. So notice it says the documentation submitted, does not indicate the time was personal, one-on-one contact with the patient, and the duration of the needle placement or retention. Therefore, it cannot be supported.

So we have to start to look at what is it that we need. So the American Acupuncture Council, we provide at our seminars, this list here of the acupuncture codes, their description, but more specifically also the details of what the requirements are. So let’s pull this up a little bit. As you’re familiar with, acupuncture has four codes.

Two of the codes are for manual acupuncture, meaning, and certain needles with no electricity. And then the other two are for electro acupuncture, meaning inserting needles with electricity. In both instances they work the same. So let’s make sure we understand what these codes mean. They say for 9 78, 10 it says acupuncture one or more needles.

So the first thing you’ll notice what we need to document. Is that we’re inserting needles, so you have to have, what points are you inserting? That’s number one. And then of course it says without electric stimulation. So it means nothing there other than just the manual insertion. But then it says initial 15 minutes of personal one-on-one contact.

So we’re gonna highlight just on the basis of this code, you’ll notice there are two things you must have. You must have the time. That you’re there with the patient, but also the points of insertion without both, it’s not billable. So be very clear in your documentation each time you do a set of acupuncture, how much time did you spend and what were the points of each set?

Because notice 9, 7, 8 1 1, the additional set gives you the same parameters, each additional 15 minutes of personal one-on-one contact along with reinsertion of needles. Now, I’ll be very honest, I’m not a big fan of that term reinsertion because it gives a connotation that you may be taking a needle and putting it back in.

And of course, that’s of course against clean needle technique. So we have to be clear that it is inserting a new. an additional needle. So again, points and time and notice. It’s the same for electro. Whether you’re doing electro or manual, we have to have points in time. The difference for electrodes indicate what needles were electrified.

That’s all we have to do. So think if there’s two things, you must have time. and points, but let’s be clear, what does this time indicate? This time, as you notice, each code says 15 minutes, and I wanna make sure everyone sees that the 15 minutes. That’s true. But for 15 minute codes in C P t, same applies for physical therapy services.

Whenever there’s a time code in this way, time doesn’t follow 15 minutes, but what’s called the eight minute rule. So the actuality is that do you have to actually spend 15 minutes for a single. You don’t, you could potentially spend as little as eight minutes. Now, frankly, I don’t think too many people are gonna spend as little as eight minutes, but nonetheless it could be.

So let’s talk about how this 15 minute session is defined. What is this 15 minutes? Is it the time that you’re inserting the needles or is it more than that? So you notice here it says this means that the physician acupuncturist is in the room with the patient and is actively performing a medically necessary.

that is a component of acupuncture. And so what does that include? Literally everything. As soon as you walk in the room with the patient, that’s an activity of acupuncture because you’re asking the patient, Hey, how are you feeling today? Because notice what this includes, the history, any day-to-day evaluation, tongue pulse, palpatory findings, range of motion, whatever you do, including cleansing the hands, choosing and cleaning the points.

Inserting, manipulating, adjusting, anything like that, but also including removal, the disposal of needles, as well as completion of chart notes. So what I want you to think of acupuncture begins when you walk in the room and say, hi, Mrs. Jones, how are you feeling today? That literally is the starting point of the first set.

Because it includes that pre-service, the intra service and post-service work, even the time as you’re finishing with the patient, giving them home recommendations and writing it down. So what I need you to do is to document that. What time did you enter the room? What time constituted the first set, if you will, or when you left or came back.

Just make sure it’s there. And frankly, you can do it one of two ways. If you want to indicate that I spent 12 minutes, 15 minutes, 18 minutes, that’s. If you would prefer to indicate I started at 10 and ended at 10 22, that’s fine as well. But you’ll notice as I mentioned, the eight minute part of it. Notice one unit or one set of acupuncture could be as little as eight minutes.

Now for the first set, that’s pretty easy. I don’t think anyone’s gonna spend less than eight, cuz it includes all those things. Now the additional set, though, is also eight minutes. But notice how this. It’s eight minutes plus 15 because the second set must have a minimum of eight, which means you must complete the total time of the first.

What I’m getting to is you can’t do eight minutes for the first eight minutes for the second. That’s not two sets. Eight plus eight is only 16 minutes, which means one set. So a second set doesn’t begin until you spend 23 minutes or more face to. notice for the third set does the same thing. It’s 38 minutes, which means two sets, two full-time, 15, 15, 30 plus eight.

So it’s always eight into the next. And remember, there must be additional insertion. So by example, if you have a patient, they come in, you spend maybe eight to 10 minutes interviewing palpating and inserting the needles, and those needles remain in the patient for 30 minutes. You then remove those needles, sit the patient up, discuss with them, even though the total time might have been 30 minutes because of the retention, there was only one insertion.

So remember, whatever is the minimum, if it’s the insertion or time, it’s gonna default to the lesser. So be very clear because you have to indicate the time of active care. It’s not just the time that the patient is resting on needles. So be very clear that rest time is. If you’re leaving the patient arrest on needles, often you’re not in the room anyway, so that time wouldn’t count.

So be clear in the notes, how much time was spent face-to-face, what were the point of each set. Now, along with that, what I wanna focus, oops, I move that. Excuse me. Let me move this up. Here we go to make sure you can see where this comes from. This is a document from the company Regents, which is part of the Anthem Blue Cross Blue Shield Network.

But the reason I included it is I wanted you to see how they indicated it as well. They note the acupuncture codes as we’ve talked about, but notice it indicates seven minutes or less of a single service is not billable. That’s true for any time service. If you do only seven minutes of. That doesn’t count either.

So make sure it’s at least eight minutes and notice the same protocol. Eight to 22 would be 1, 23 to 37 would be two, but that includes that you’re doing a second insertion and so on it goes. So that sounds good. That doesn’t seem too hard, but I know for many of you, you’ve come to me and say, Hey Sam, you’re the expert.

Can you give me an example? So here’s an example of an office, and this is one that actually was. and past. I wanna make sure you can see that this is what you need to do, or at least something similar. Notice how clearly it’s indicated here. Treatment set one, it says the face-to-face time. It then indicates what points were needle.

It then notices that there’s eim added to two of the points, which means is this enough to bill for one set? Absolutely face-to-face Time, 20 minutes with those insert. and electricity electrical set. Then notice though it does something unique. It says needle retention after insertion was 12 minutes.

That’s fine if the patient’s resting on needles indicated. Then when you come back in the room, then you’ll indicate again after the patient rested with needles. Maybe they were withdrawn and repositioned. Do. Keep in mind, you do not have to withdraw needles for an additional set. It could just be more time and insertion.

So notice second set says face-to-face. Time is 18 minutes. It then highlights the points and then talks about if there was e-stim. But notice how clear this. From this, I bet you could all perform the service. What I want you to think of is that you should document in a way that another Accu Acupuncture could read it and go, oh yeah, I’m familiar with that.

Now you could argue maybe Sam, it doesn’t take me 20 minutes to insert those. I agree. It doesn’t take 20 minutes just to insert, but all the things that go on before the insert. During, and then of course even after just resting on needles doesn’t count. So anything you’re doing, that’s the component of it.

I want that time to count. So be very clear in your notes. The time acupuncturists generally indicate they spend more time with their patients than most other providers, and I would agree as an acupuncture patient I can certainly say that. I just need to make sure you document it. So here’s one simple example to do it.

Notice points and time for each one. Let’s do another example of a soap note. Now, this is an example SOAP note for those of you that are part of the American Acupuncture Council Network. In our ACU code, we have a template of this that you can use, but let me show you how it works. What it does is it gives a breakdown of the treatment, so you’ll notice what it.

It gives a very simple, what were the sets? Notice set one, two, or three. If you have more, you would just add a line, but notice it indicates the points and then the face-to-face time. Now this one’s a little different. This one indicates five 20 to 5 45. Either ways acceptable. If you wanted to put 25 minutes, that’s fine.

Notice the retention time is separate. They just make sure retention time doesn’t count towards face-to-face. And then notice each set does it that way. So don’t make this overly complicated. Make your notes in such a way that someone can read it. You can show them the time you spent face-to-face the points, and then do that same thing for each set.

Just realize that in order to bill for three, as you can see here, there’s gotta be more than 38 minutes face-to-face and insertion. So let’s take a look. This is 25. Notice this one’s only 10. Now it’s 10. Still enough? It is because it has to be at least eight. But remember, for three sets we need 38 minutes.

So 25 for the first. 10 for the second that brings us up to 35 plus an additional 20. That’s 55, so that’s more than enough than it would be required for the time. In fact, if there were a fourth insertion in there, could that have been a fourth set? Maybe. What I wanna point out though is that you might look and go why did they spend 20 minutes on this one?

At the end, when you remove the needles, is there time you spend with the patient taking the needles? Discussing with them the treatment. Realize all of that is a component, so I need it to be clear in your notes. Give me the time you’re with the patient for acupuncture. Remember, exams are separate, but for acupuncture as well as the points of insertion.

And remember, could it be one point? It could be. Generally it’s multiple, but it could be. Then notice the other thing. Notice the infrared heat. Infrared heat, lumbar spine for 20. , not a problem. There again, very clearly. What I want you to think of is, could you read this note and perform it and think of that as the gold standard.

Another provider can read it and clearly identify this service and could perform it. Again, you might say you spend less time because I know acupuncturists could put needles in fast, but remember, it’s not the time you’re putting the needles in only, but all the things that lead up to during and after that are a component, so don’t over complic.

But do make sure it’s there. When someone looks at it, can they clearly see the time? Can they see the points of insertion? Of course, we all know that this year, 2022 is the year of the tiger. Next year is the year of the rabbit. But what I’m gonna say to you is, you know what? Acupuncture is always in the year of time.

You bill a time related service. You need to indicate. Now remember, it’s face-to-face time. If the patient is resting on needles, that doesn’t count towards face-to-face unless while they’re resting, maybe you’re stimulating. That could work, but not just the period of resting. I know the acupuncture side go to often what she does is she’ll spend 10, 15 minutes insertions.

She then leaves the room for a while. I’m sure she’s probably treating someone else the time she’s gone. She comes back in the room and generally at some points, once she comes back in the room, that time. and then again, the time she spends with me, even after the needles, taking them out, doing the notes and so forth.

So just make sure time is there. The thing I run into that’s difficult for me to defend is when I don’t see any of that in your notes. So be clear for acupuncture time. And points must be documented. If you do, you’ll resolve almost every issue I’ve run into when it comes to acupuncture documentation.

Let’s get ready. How many of you have an expert on staff or someone you can go to? I am the expert. Let’s get ready for 2023 updates, coding changes, fees, and all those things are gonna be occurring soon. Go to our site, go to our network. We’re there to help. We’re always gonna be a resource for you. The American Acupuncture Council is always your.

don’t be afraid to reach out. Be careful. Don’t use Dr. Google. Go to a trusted resource. Until next time, everyone wishing you the best.