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Acupuncture and Timed Therapies – Sam Collins



And one of the things that I get commonly, whether it’s a network member or someone coming to a seminar or someone reaching out from acupuncture today is how do I manage acupuncture with time services?

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Greetings, everyone. This is Samuel Collins. You’re coding and billing expert for acupuncture in the American Acupuncture Council with another episode. Let’s solve problems. Let’s make sure you have the right things documented. And one of the things that I get commonly, whether it’s a network member or someone coming to a seminar or someone reaching out from acupuncture today is how do I manage acupuncture with time services?

How does that mesh if I’m doing a manual therapy or a massage? How does that time incorporate with acupuncture? It’s actually not as complicated as you think. However, it’s something that I’ve learned because I teach in a lot of schools. Acupuncturists aren’t learning. So we wanna give you a better learning curve now to do this properly.

So let’s go to the slides. Acupuncture and timed therapies. How do we manage ’em? What’s the proper way to document these time therapies along with acupuncture? And what are the minimum times, because obviously you’re all familiar with the 15 minutes, so what does that really mean? So let’s talk about what are these 15 minute services and time services.

Obviously we know we have acupuncture. We have the four codes for acupuncture. The two first ones obviously for manual acupuncture. The ladder two are for electro acupuncture, and each of the codes indicate that you spend 15 minutes. Now remember that 15 minutes is 15 minutes with the patient. in the room.

So by example, when you go in the room to greet someone, realize your time starts. So one of the things I find acupuncturists often miss out on is the true understanding of the value of time. The time is not just the point of inserting the needles, but it’s all the things required to do such as, Hey, Mr.

Jones, how are you feeling today? So that 15 minutes is incorporated into the acupuncture codes and is a requirement for each set. Now what about therapy services? Now, I picked a few here that I say are maybe a little more common. I won’t say these are the only ones, but I picked electric, stem, ultrasound, auricular electricity to accu points, exercise, massage, manual therapy.

As I would say, these are generally the more common ones that are timed. They’re more than these, but, and you may be doing additional ones, but the big issue is how do I make sure the time for those. Meet and adjust with the time for acupuncture. If I’m doing them together, what are the minimums here? And this is the concern that we run into a lot of problems with that.

Someone will not document enough time. I generically will tell you, acupuncturists spend more time with their patients than most other providers, whether are chiro. PT or medical doctor for sure. I think acupuncture spend a lot of time because the way that you work, the type of services you provide. So let’s talk about how does acupuncture work.

Now, this is actually a page out of the C P T, and I’m just using that to make sure everyone can see. It’s not just us stating it, but in C P T, it indicates that there must be 15 minutes of time that’s face-to-face with the patient. Now, face-to-face doesn’t mean touching. Sometimes people think contact means, do I have to be contacting the patient?

No, it just means. You’re in the room. So literally once you go in, it counts. So I wanted to make sure you can see it from that standpoint, but let’s take a look at it as it’s written out. Each code indicates pretty much the same thing. It says acupuncture. Of course that means needling with one or more needles and then says without electric stent, because these are manual and it says 15 minutes of personal, one-on-one contact.

So that simply means we’re in the room with the patient having contact with them. For the acupuncture service, which includes the pre, the during, and even the after. So the first set says 15 plus needles. Notice the additional set or additional sets says the same thing. Each additional 15 minutes of personal one-on-one contact with reinsertion of needles are really an additional insertion of a needle.

So bottom line is 15 minutes plus insertion. Equals each set. Now that goes with whether it’s manual or electrical. The only difference of electro acupuncture codes, 9 78, 13 and 14 is that at some point the needles have electricity attached. So you’re doing some type of device where you’re con contacting the needles and having electricity throughout.

Bottom line. It’s just simply 15 minutes per set. Pretty straightforward, but sometimes people have a hard time understanding. What does the 15 minutes constitute? We’ll get into that because let’s look at what other codes are. 15 minutes. Now, this is a list of all of the common physical medicine codes.

If you’ve been to a seminar with me, if you’re part of our network, of course you have access to this. And all this is a simple list of therapies you’re gonna notice in the upper left side is gonna be the unattended therapy supervised. The constant attendance, the therapeutic procedures plus the acupuncture, even dry needling listed nonetheless.

Let’s talk about specifically what are the timed services? Timed services are the ones that indicate time. You’ll notice the first ones that say supervise like. Infrared heat or something, they don’t have time, so these don’t matter. Those you just do or don’t do. There’s no minimum or maximum.

However, where you see ’em say constant attendance, you’ll notice now each of these indicate 15 minutes with each. So much like acupuncture. That means you have to spend 15 minutes with the patient. Now that doesn’t mean necessarily that your hands on though it could be, but it means you’re with the patient as the therapy is being provided to monitor the efficacy of it, if you will.

Now, commonly it could be electric stem, handheld type, not a type where you put pads on where you hold it by hand. Here’s that code I mentioned, the electric stimulation of auricular, acupuncture, literally electrical impulses to the surface of the year. at acupuncture points but not needling.

Those all indicate 15 minutes. In addition. In 15 minutes are the common ones that you’re gonna do. And of course I think most acupuncturists, and I shouldn’t say most, but many do incorporate therapies as part of their practice and may do some body work with a patient, whether it’s twink, haw and so forth, certainly gonna be applied to it.

And those notice all indicate 15 minutes. So what this is focusing on is making sure do I have the time? and understand the timing of it. I just taught a class last week to students at Emperors College, a college acupuncture college in Southern California, and I was surprised to see how most of them were getting ready to graduate and really had not learned anything about time.

So it’s one of the reasons their instructor had me come in, because it’s one thing to learn to be a really good acupuncturist, but we do have to understand the business end of it. How do I document this? And I don’t care if you’re not billing insurance. , you still have to document the services you’ve provided.

So let’s talk about the acupuncture time. What does it mean? What does it mean to do time in general? Now, what you’re seeing here is actually taken directly from cms. As well. And when CMS means Medicare as well as the American Physical Therapy Association, the ama, and all the adaptation of this, and it talks about counting time, and I want you to notice when time is not just time touching the patient, but notice it says time of therapy includes.

Assessment and management time, medical record review, physician contact while the patient is present. And so what it means is when you’re in the room and you’re looking at the notes and you’re getting ready to start part of it, thinking, okay, last time I did this and I’m doing, you’re gonna count all that time.

So what I’d like you to do is start thinking of when you go into the room, Either you’re starting acupuncture, so the time starts then, or maybe you’re gonna be doing a therapy. It starts when you contact the person. So this means the things you do before the service, that’s part of it, if you will. In addition, of course, it includes the hands-on treatment time, obviously, but then it’s also post-service work.

Notice that includes things like assessment of treatment effectiveness, after you’ve done making sure the patient’s feeling okay, sitting upright, making sure they don’t have any needle sickness. All those things would be included. But notice it also says, Communication. So you know those few minutes you might spend with a patient at the end of the visit communicating some things about their therapy that would be included.

I wanna be careful. It’s not overstate post-service time, but it’s certainly part of it. Here’s why we have to make sure we’re accounting for it, because I know the codes save 15 minutes. But the codes have what we refer to as an eight minute rule. Now the state minute rule is put out through C m S and adopted by every insurance, and it talks about the time required for a time service is actually not 15 minutes.

The time is actually as little as eight for one unit. It means you’re doing more than half. So the bottom line is if you were to do acupuncture or a therapy for as little as eight minutes, it could be billable, assuming there’s only one unit or set. Now, here’s where things get slightly tricky, but not too hard to understand.

Notice it breaks it down one unit. Of services. Now, I’ll even say one set, cause I like to think of acupuncture and sets. Notice one unit is as little as eight minutes, but notice it goes all the way up to 22 minutes. So if you’re doing a set of acupuncture or a therapy anywhere from eight minutes up to 22 minutes, that is simply one unit.

A second unit or time factor doesn’t begin until you’re eight minutes into the next service, which means now it’s gone to 23 minutes. So notice 15 plus eight, always the eight minute part. So it goes in that pattern all the way through. Notice two units or sets would be as little as 23 minutes. Three would be 38, 2 meaning 15, 15, 30 plus eight, and so on.

It goes all the way through. Now, that’s not too hard to see. However, it becomes an issue when, what if I’m doing two services, obviously, like acupuncture, I might just do ’em, look and go, okay, I did that, but what about a time service? And this is where things get confusing. . Where does that time count?

And again, I wanna make an emphasis here for your acupuncture time because I think many of you forget what constitutes it. It’s not just picking points and inserting needles and removing, but it includes all these things in red. Include a review of history. When you walk in the room and say, Hey, Mr. Jones, how are you feeling?

That’s when the time starts. It includes day-to-day evaluation, pulse points. Tongue, maybe range of motion, whatever you do. Obviously, cleaning your hands, choosing and cleaning the points, inserting, manipulating the needles, removal and disposal. Wow, all of that’s included exactly as well as completing the chart notes.

So clearly there’s a lot of time. If it’s an activity that’s related to acupuncture, it certainly counts what doesn’t count, and I underlined this at the end, the time the needles are retained is excluded. So be careful. You know how you might have a person rest on needles for 10 or 15 minutes? I. Perfect.

I know when I go to the acupuncturist, generally when she inserts needles for about 10 or 15 minutes, usually says, Hey Sam, I’m gonna leave you here and let you cook for a little bit, if you will. And then she’ll let me lay there for 10, 15 minutes, relax, and then come back in. That time does not count.

Now what if you did stay in the room though? What if you stayed in the room and every few minutes you stimulated the needles or you’re looking for patient response whether to insert more? That will count and it would count if it as an additional set once you would insert more needles along with that time.

The key factor here though that’s complicated is that I can only use one time code at a time. I can’t do two time codes and I have to meet the minimums. And what I think probably makes it simple to think of whether you’re doing acupuncture by itself or acupuncture with a therapy time is cumulative. So it’s not a separate time for additional services.

It’s an included time. So even though you might be doing two different things, massage and acupuncture, The minimum time to build a unit of each means you must spend 23 minutes total with no one of them lesser than eight minutes. So one thing to keep in mind though is let’s document this. This is not hard.

You spend a lot of time. You know what I’d like you to start doing. Tell me what time you entered the room, what time you left. , if there’s a particular therapy, tell me what time you started, the efforts of that and what time it was completed. But do keep in mind time documentation is only two ways it can be done.

You can either tell me how many minutes you spent. That’s easy enough. I spent 15, 18, and so on. Or you can say I went from nine 30 to 9 45. Now where I would be careful, I find often when people state minutes, their minutes are off in an average, and you may be undervaluing it. . My preference would be to actually tell me start and stop times.

Now either is acceptable. Just be careful of shorting yourself. You ever have that where someone says, Hey, how long does it take to get to whatever particular location? They go, oh man, it takes 10 minutes. Then you go to get there and it takes 25. You’re like, what? They’re telling you often 10 minutes to make an enticing, but also to say, Hey, if it’s perfect traffic, maybe I want to know exactly, so let’s make sure we’re documenting it right by telling me how much time.

Whether it’s total minutes or from and two, what’s unacceptable, and this is where you have to be careful. Don’t state doing one unit. You can state that, but then you have to define one unit by how much time, don’t indicate a range. You can’t say, Hey, I spent somewhere between six and 18 minutes. It has to be a certain number.

It can’t be a range. It also can’t be, Hey, I just did it times two. What do you mean by times two? , and then of course, not just indicating any time by just saying, Hey, I circled acupuncture. A set massage. That would not be adequate. So by example, let’s take a look at this. If I’m doing acupuncture and I spend 10 minutes on the first set, that would be billable.

I circled to say that would be one set. What if I add an additional set in there for another 10 minutes? Would that be billable? What’s the amount of time that we spent? 10 plus 10 of course is 20. What does that mean? Only one set is billable. Now obviously it’s too short. Now you’re gonna say, but Sam, it went over eight minutes.

Yes it did, but it didn’t meet the time for the second unit. What if I spent a little bit more time? Let’s take an example. What if I did acupuncture for 12 minutes face-to-face, and then the additional set I did for 12 minutes again that will be 24. Which means above the 23 minutes and I could build both sets.

In theory you could do 11 minutes on one and 12 minutes on the other. What I wanna focus on here is just be careful that you do have to add the time for cumulative amounts. So for tunes to be billed, we have to have that minimum. Which brings me to what we started with was talking about therapy.

What about time therapy when it comes to acupuncture? Now, if I’m doing infrared heat, doesn’t matter because infrared heat doesn’t have a time value. You either use it or you don’t use it. However. Let’s take an example here of acupuncture and you did 15 minutes on the first set, 10 minutes on the second, which I would say isn’t unusual.

Obviously the first set may take a little bit more time. I do want you to keep in mind though, the second set does include if you’re face-to-face, finishing the notes. So if I did 15 plus 10, good. Now I did another 10 minutes of massage. It meets the eight minutes, but let’s total this up. 15 plus 10 is 35 minutes total.

If I did 35 minutes, how many units are set can I bill? Based on the eight minute rule, what’s the min minimum time for three is 38. So this would mean this would not be billable for the massage. I would build a two sets of acupuncture. Now, you may ask Sam, why are you gonna build a two sets of acupuncture?

They have a higher value, so I would pick the ones with the highest value, but we cannot bill all three. If I were to bill all three, I would have to have spent somewhere either three more minutes on this set. Three more minutes on this, or three more minutes on the first one. The total time. has to equal 38, so be very careful.

This is where I see people run into problems. They forget to look at the cumulative nature. Think of it simply, if you were to do massage only for 35 minutes, could you bill that for three units? No, not enough. So it doesn’t matter that it would just be one service or multiple, but let’s take an example using the same idea.

We did 15 minutes of the first set, 10 minutes on the second, and then 15 minutes fully of massage. What’s the total time there? The total time is 40 minutes. This means all three services can be billed because the minimum time of eight minutes was hit for each, and the cumulative time was over 38 minutes.

So what I’d like you to think of is just start getting in the habit of these time services and units to do them in this way. Please, I hope you’re not looking going, oh, this is too complicated. It’s not at all. You’re just documenting the services you have done. And I want you to think of this way.

Documentation should be a way that someone can look back. and go what was performed on that visit, and I’m talking a complete risk management of this. What if a patient were to say, I don’t think you did all the services, or was, making an issue of money. This would be the way to make sure you’re gonna say no.

It’s all there. I would love for us to be in the habit of it. Frankly, I’m frustrated for some acupuncturists because your time is something you do a lot of with your patient, but because of your lack of documentation, when notes get reviewed or people make an issue, , we cannot defend it. So let’s just start putting the time down.

You’re spending it. Let’s meet it. So eight minutes minimum for 1 23 for two. Get in the habit of that, whether it’s acupuncture or therapies, will make your life simple. Now, keep in mind, Acupuncturists aren’t doing a ton of services. You know why most people go to an acupuncturist? To get acupuncture.

But isn’t it good sometimes to get some additional services? I know when I’ve gone, I’m a big lover of cupping. I find that’s really helped me with some shoulder issues. But also there are times where they’ve done some gua or deep tissue work, and I would say there’s ways that acupuncture stood that others don’t, that you might be doing slightly differently and maybe have a better outcome.

Don’t be afraid of additional services. Just simply document them. We wanna make sure you’re getting the patient the best care, but I also wanna make sure you’re getting reimbursed. That’s what we do at the American Acupuncture Council Network. We’re here to make sure your offices continue to thrive and make more money.

If you would love to have an expert to be on your staff, you know you can hire me for less than a dollar a day. You can zoom with me. We can do one-on-ones where we go over your fee schedule, audit your files, make sure everything’s compliant with the big issue of not so much compliance but reimbursement.

Your practice is going to continue to thrive because of your ability to run it as a business. Allow us to help you do that. Take a look at the American Acupuncture Council Network. We’re here to help. Until next time, everyone, I wish the best, continue to be that good person to all your patients. I’m counting on you.