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Acupuncture and Therapies Sam Collins



And we’re gonna talk a little bit about reimbursements today in the sense of, let’s talk about the acupuncture scope of practice and more specifically therapies.

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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. We’re back for another episode. Thank you for being with me. This is Sam Collins, your coding and billing expert for the American Acupuncture Council, specifically the network, your compliance, billing, coding, and most importantly, reimbursement expert. And we’re gonna talk a little bit about reimbursements today in the sense of, let’s talk about the acupuncture scope of practice and more specifically therapies.

Many of you are doing therapies, and I’m not saying you have to do therapies, but many of you do, and for the most part they are reimbursable. We wanna make sure when they are reimbursed that we don’t have any issues with that it wasn’t documented properly. Or some of these things some of you run into when you get denials because they look at your notes and go, wait, it wasn’t there.

I wanna make sure you know the quick and easy of how to do it, not complicated and whether or not who may provide them. As you’re familiar with physical therapists, chiropractors can use assistance. But can an acupuncturist. So let’s go to the slides. Let’s talk about what is the scope of practice for acupuncture.

So let’s look at the acupuncture scope of practice and look at what’s going on for us, what’s allowed, who may perform it, and all those things. I mentioned now generically, the scope of practice. Is one that it generally states this type of issue here, and I’ve just given an example. It means the stimulation of certain points or points on the surface of the body by the insertion of needles.

So in other words, inserting needles. That’s acupuncture. But beyond the acupuncture, of course, what else can you do for therapy? So you’ll see here it talks about, Generically perform the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold magnets, nutrition, diet, nerves. In other words, much more than just.

Inserting needles. Now, this specifically is the California rule. Let’s look at another one here. Let’s take a look at Massachusetts, cuz sometimes these rules are somewhat vague or very specific. I’m gonna say, please know your state regulations because some states have more generous allowance, some have less.

So here’s Massachusetts. It talks about adjunctive therapy, so that means things beyond the acupuncture. But notice what it says shall include. But not be limited to. And whenever you say it shall include, it means these things. But of course, more. And I would say pretty much everything you learn or are taught in a standard acupuncture curriculum.

So this is gonna include lots of things in therapies, but also things like what they stayed here for Massachusetts, nutritional counseling, herbology. Recommendation of breathing techniques and exercises and lifestyle, behavioral supportive and educational, and even stress counseling. I wanna focus in on are those things billable?

That gives a pretty broad notion of could they do massage? Sure. That would be something that would be a. Not limited to. Then we’ve got someplace like Florida, which really lays out a ton of things, and I bolded it here. Notice Florida says manual stimulation, accument even goes so far to talk about massage, acupressure, shsu, even tuna.

Electric stem laser, and then even goes into the details of what type of Oriental massage you may have notice here it talks about acupressure, amma ammo, gua rah, reiki, and so forth. Again, given the details, so again, you can see this is a very broad scope. They can do many things. However, let’s take a look at New York.

Some states are more restrictive. It says, the profession of acupuncture is treating by means of mechanical, thermal, or electrical stimulation affected by the insertions of needles or by the application of heat pressure or stimulation at a point or combination of points on the surface of the body. Now you notice here the much more restriction, it doesn’t give adjunctive therapies.

It specifically says heat pressure and electric stem. It doesn’t talk about exercise. Massage or manual therapy. So you wanna be a little bit more careful now as restricted as you will as New York can be. New Jersey across the border, it’s gonna have the most generous, I’m just pointing out, please know what you can provide within your scope.

I’m gonna take the generic standpoint of, for the most part, acupuncturists can perform standard physical medicine services, physical therapy, and so that’s gonna be this listing here. If you’ve ever attended a seminar with me, you’ve seen this type of list where I give you the common C P T codes. You’ll notice that we include acupuncture, of course.

That’s something you can do by nature. Can an acupuncturist all do also do needling? Oh, of course, if you’d like to. Never the same time, but you could. I would recommend acupuncture, of course, but it includes also doing modalities such as heat or electric stem, but also constant attendance ones. What about electric stem?

That’s manual. How about even laser? Notice there’s two different codes for laser. And then of course we have the other things like exercise, massage, manual therapy, even therapeutic activities. And a lot of these, sometimes people are going what do these all mean? What are they? And so I like to think of it, not so much as trying to reinvent and trying to teach you something new, but let’s talk about the things that are commonly done in an acupuncture practice.

What are common therapies? Of course, heat, I would say majority of acupunctures I’ve ever met use some form of heat, whether it’s infrared. TVP lamp. I’ve seen hot stones, hot packs, but heat almost always in scene within scope everywhere, but would also include things like electric stem. Now, I’m not talking electric stem of the acupuncture.

I’m talking electric stem generically, like on the surface, like a TENS unit or the little pads people apply. That’s not uncommon. But it also includes all types of body work, meaning massage or manual therapy or just soft tissue manipulation. I put it generically, this could include twink. Even Gua to an extent, we have to look at word of those fit, but it also includes, and this is something that I think acupuncturists often forget, the active therapies like exercise.

These three codes are in fact covered under the VA program, which are gonna be just standard exercise, therapeutic activities, more functional, and then even balance or coordination training with neuromuscular education. I’m gonna say these are probably the four or five things that are pretty common now with, on that, I would say also cupping in moxa.

Outside of the va, though, we don’t find commonly cupping and moxa will be paid, though I’m not saying not to do it, not to bill a patient. And or the insurance. What I can only guarantee is it’s payment under the va. But nonetheless, these are the common ones. Now, you might say Sam, I’m doing a few more.

That’s okay. If it’s within scope, I’m all in, but I wanna talk about the common things to make sure, are we documenting it properly? So let’s talk modalities, things that you can apply to a patient. But you don’t have to be there. Like you can turn on an infrared heat lamp or a TDP lamp. Let the patient relax, let that heat do its work, but you don’t have to stand there while they’re doing it.

So we say those are unattended, which means there’s no time. So you either do it or you don’t, and you bill accordingly. But we still have to make sure how we’re documenting. And the same would apply. What if you’re doing a modality that is timed? So what does documentation need? Infrared heat. It’s as simple as saying you applied infrared heat to the lumbar spine or whatever, the body region.

Now you’ll notice here I put 15 minutes. Is 15 minutes required? No, because it’s a modality that’s unattended. I’m putting 15 minutes so that I know in my notes how much did I do last time. What I’m pointing out though is that the time that you do it is not going to change how much you can bill. It’s one unit only.

Nonetheless, the key factor here is indicating where I had a provider. And this is with United and a few others that got denied for infrared heat because when they reviewed their notes, it didn’t indicate where. Now the provider said Sam, I was diagnosing the patient’s low back, so obviously the heat had to go to the low back.

I don’t think that’s an illogical explanation, but it doesn’t fly. Always make sure to simply tell me what type of heat where’d you do it. In addition, what if you are doing electric stem? Tell me what type are you doing? Two pads, four pads. What’s the intensity? In fact, the easiest way to think of this should be documented in a way that any person reading it would know how to apply it.

If I told someone, put a hot lamp on their low back for 15 minutes, would you be able to repeat that? I don’t think too much trouble or if I said electric stim in this manner. So think of documenting as just a way of highlighting what you’ve done, not by checking a box. Checking a box that says I did heat would not be sufficient because where did I do it?

What type of heat and so forth. And that even gets more confusing when you look at some of the hands on stuff like massage versus manual therapy. What is the difference? They’re very similar. Generally manual therapy is more focal, I’m going to say probably I. Deep tissue, if you will, that’s focused on a trigger point is probably gonna fit more manual therapy, whereas the more generic stroking and relaxation would be massage.

The key factor is document what you’re doing with either one to differentiate between the two. So tell me what type of massage you’re doing, or trigger point or myofascial release. Lots of ways of describing it. Tell me how much time you spent, because this is a time code now you can put start and stop times.

You can say I started at 11, ended at 1135. Or you can say I did 35 minutes. Either way is acceptable, but it is absolutely required that you put how much time, like acupuncture, you have to have the time element. So simply document what you’re doing in a way that when someone looks at it, they can see what was done.

And then of course, always have a little bit of, why’d I do it? What was my purpose? What was the outcome or the goals? Give a little bit of how the patient felt after the visit. Did it accomplish what you’re looking for? Even exercise acupuncturist, if you think of probably, The most ancient form, if you will, probably stems back to acupuncture.

When you think of Chiang Tai Chi and those types, the enhancement of the physical culture of the body. Now, that doesn’t mean you’re turning your office into Gold’s Gym, but what if you are doing some exercises or you’re putting the patient through a series of stretches or other types of exercise, yoga.

Otherwise, absolutely. Just tell me what you’re doing. How many sets, how many reps, or whatever the amount of time that you’re spending. The key factor is when you’re documenting anything that’s time. Do remember the eight minute rule. This is the same. That’s true for of course, acupuncture. Remember, one unit can be as little as eight minutes.

That’s perfectly fine for one unit, but to get to two units, it has to equal 23. So let’s say by example, you did 10 minutes face to face for acupuncture and 10 minutes of exercise. Would that be acceptable to bill two units, meaning one of each? The answer is actually no, because if you think of it, if I did 10 minutes and 10 minutes, what’s the total number of minutes?

Only 20. Therefore, that’s not enough for two units. Notice two units takes 23, so it’s 15, if you will, plus eight to the next, so you gotta make sure it adds up. Now, by contrast, if you did 11 minutes of acupuncture face-to-face, and then 12 minutes of exercise. That actually would count. It’s that specific.

Tell me the time. Generally, when you write the time down and you really put from, and two, you’re gonna find, you probably have spent more time than you realized. If you just simply wrote, you spent 15 minutes, you may or may not have spent 15 minutes, often spent more. Keep in mind, look here on what is acceptable for documenting time, though don’t make this hard.

There’s two ways to do it. Tell me how many minutes I’m right here. Or just tell me from, and two, from nine 30 to 9 45. I’m okay with either, but get it in there. What’s unacceptable notice are the generic things like just putting down that I did a unit or telling me that I did an average time. I saw someone said I spent 25 to 35 minutes.

Huh? Either you spent 25 or some number up to 35, but not between that. So just be specific and then please don’t fall to where you just say, I did two sets or two units. It’s gotta be time. That’s not very hard at all. In fact, I think if we were taught that initially in school, probably be a lot easier for many of you.

But just think along those ways. Tell me how much time you spent. I am invariably fine when I help to audit and deal with these types of issues when I talk to the doctor. It turns out they often spend a lot more time than they’ve documented simply because they try to average. It’s what I call, if you tell someone, oh yeah, it takes five minutes to get there.

Does it ever actually take five minutes? Maybe not. That’s the idea. Once you get on the freeway, tell me how much real time it takes, and then let’s follow with, can I use an assistant to perform these? Now as an acupuncture, can you do these clearly part of scope, part of the services.

In fact, the VA encourages it, but may you use an assistant. The answer is no. There’s no laws that create acupuncture assistance in the way that can do therapies under your supervision, meaning that you bill for it. If you are billing for it, you have to provide it. Now by chance, if you had another acupuncturist working for you that did it, then I would say yes, but not someone that’s not licensed under you, if you will.

So keep in mind, we’re not there yet. I’m hearing rumors of some states and I’m hearing maybe Arizona’s gonna be the first one, but as of now, you would need to do all the services that you bill for. You cannot have. A staff person. Now, I know there’s some states that allow people to pull needles, things of that nature.

But again, keep in mind as far as the therapy, no assistance. Now, I’m hoping we get a change there. Obviously chiropractors use them, physical therapists use them. I would think acupuncture should also, but until we have the law, I’m going to say no. Let’s not make this hard. The main thing you do is acupuncture, but there may be therapies that are adjunctive.

Make sure they’re in your scope of practice. Make sure they’re documented. And your dog on you’re gonna bill for it. That is money you deserve and should be paid if you’re not billing for it. If someone’s willing to pay you an extra 50, but you don’t bill for it, they’re not gonna pay it. That’s what I do for you, is to make sure that we can help you get paid.

That’s why we do these programs. It’s what we’re doing for you. If you want some real day-to-day help some that can really make sure you understand what fees should I have, how do I document it properly? Can you help me office, Sam, make sure it’s okay. My job is to always make sure that you honestly just have a better business.

Meaning one that is compliant, but one that also makes sure that you’re getting maximum reimbursement. Give us a look at our website. Otherwise, I’m gonna say it all you. Thanks for being with me. I’ll see you next time. And until then, continue to take good care of your patients.

See you next time.