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Acupuncture Malpractice Insurance – Getting Paid with Timed Series Documentation



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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. It’s Sam Collins, the coding and billing expert for acupuncture and the American Acupuncture Council. We’re here for you and we wanna make sure your practice continues to thrive. Let’s get into it. Let’s talk about what’s happening with documentation of acupuncture services, specifically time services.

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This is continuously a problem and I want to help you solve that and make sure you understand it with some ease to make sure your claims are paid. Make sure you’re getting paid what you’re supposed to be paid. So let’s go to the slides, everyone. Let’s talk about documenting and recording time specifically for acupuncture.

Where we’ve run into a ton of trouble is to realize that acupuncturists probably never really learn this correctly and don’t understand the value of their time. I think acupuncturists probably more than any other provider, spend more time. With their patients one on one and any their provider, and I’ve been to lots of different types, but my acupuncturist is the one I spend the most time with.

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All I’m saying to you is that’s true. Let’s make sure to document it. So acupuncture highlights specifically time and I underline it here. Notice each of the codes indicate initial 15 minutes of personal one-on-one. Contact the additional one each additional 15 minutes with personal. One-on-one contact.

So it means acupuncture requires that you spend time one-on-one with the patient, and of course, inserting needles. Now I just highlighted the manual acupuncture, but it’s the same is true for electro acupuncture. Whether or not it’s electro or manual, please document the time. It’s the one area that so frustrates me ’cause I have so many good acupuncturists who are doing really well in getting paid hundreds of dollars per visit On some insurances, I kid you not, but we run into problems where their claims are denied and I want to see what’s occurring.

Here’s one for United Healthcare, and you’ll see here this is for 9 7 8 1 1 N one three and it says, not supported. It says the add-on type of code requires a primary code. It cannot be accurately seen. Therefore the validity of the accuracy of the bill services cannot be verified. So in other words, there’s no time you think no, it doesn’t say that.

Let’s see. 9 7, 8 1 3. The initial one says the submitted medical records do not support. 9 7 8 1 3 was performed. The documentation submitted does not indicate the time. Was personal one-on-one contact. Now notice it’s telling you the time didn’t indicate as personal one-on-one. It is not sufficient to just say time, because time could be the time the patient is resting on needles.

We wanna know the one-on-one time. Now here’s an interesting one. Notice some of the claims and initially for the followup set says not supported. Notice the initial set is, so what did they do differently on the first? They didn’t do on the second. You’ve got to get in the habit of saying, I spent one on one time.

So by example, what is this one-on-one time, and I think many acupuncturists forget what this really includes. So let’s get into this 15 minute code. The 15 minute code is personal. one-on-One contact. Literally that means on an acupuncture visit day, not with exam, just treatment. As soon as you walk in the room with a patient.

The time starts. So what I’d like you to do is look at your watch and go, oh, start at 10 0 5, or whatever the case may be. Give me specifically the start time, or at least start a timer because this means, and you’ll see here, the acupuncturist is in the room with the patient and actively performing a medically necessary act component of acupuncture.

Now, realize, what is that gonna include? When you first walk in the room, you might review their note and say, Hey, last time you said such and such. That’s included. It’s going to be review of the history, asking them how they’re feeling. Notice none of this is even yet putting needles anywhere, but just asking the patient what’s going on.

It’s then going to include your day-to-Day evaluation could be tongue and pulse, range of motion. You name it. Any of those things you might do realize includes washing your hands, sanitizing. Choosing the points, cleaning the points, getting the needles open, inserting the needles, manipulating the needles if you have to.

And of course it actually includes removal so you know how you’re in the room with a patient. You might leave them rest on needles. I. Maybe you come back 10 minutes later, as soon as you walk in the room, time starts again because the time to take the needles out and dispose actually counts and notice this component as well as completion of chart notes while the patient is present.

So that means, you finish it up when the patient’s there, that actually counts. Now what wouldn’t count is if you do it later sitting in your office, but if it’s while the patient is there, it all counts. So you know you’re asking those few questions at the end. Just gimme the total time. I love that we’d have a program somehow.

Maybe there’s a mat. When you walk in the room, the mat turns on a timer, and when you walk out of the room, the night timer goes off. Because if you’re in the room, it’s a component of acupuncture. You’re doing something towards it. Unless it’s another therapy. Now, where a lot of people get fooled on this though, because they said Sam it’s 15 minutes.

Do I actually have to spend 15 minutes? Technically, no. It’s what we call the eight minute rule, and this eight minute rule is true. For all codes that are 15 minutes when it comes to CPT, including physical therapy and physical medicine, but actually acupuncture. So I’ve given you a simple breakdown of it.

Notice one unit is at least eight minutes. So do you have to spend 15 minutes to do acupuncture? No. If I spend eight minutes and insert a needle. I can remove it and they’re out of there. That actually could be enough time. Now, I don’t think anyone’s doing an eight minute visit, but I think you get the premise here is that we’re just looking in increments that if you’re doing more than 50% of the time, meaning eight minutes, you qualify.

I don’t think anyone has any problem doing the first eight minutes. Of course, where things get a little trickier though is how do we do an additional set? That requires additional time and additional insertions, but it doesn’t require. 15 minutes. The answer is no. It requires an additional eight.

Now here’s where it’s confusing though. What if I do eight minutes on the first and go, I did eight minutes on the second. What’s the total time for eight plus eight 16? Is that enough? No. ’cause there has to be at least 23. So realize the second unit of time, that eight minutes begins after 15 minutes and it’s plus eight.

So that’s why you’ll see one unit is as little as eight, but two units or two sets is 23. Three sets would be 38. So you have to make sure that time matches. So by example, if you did eight minutes on one and eight minutes on the other, that wouldn’t be enough. It would’ve to be 15 plus eight. Or how about this?

What if you sp you spent 12 minutes on the first one and 11 minutes on the second one, would that be adequate? It would, because there’s 23 minutes, so please make sure that you’re just simply documenting the time. Notice it wasn’t saying, the time wasn’t documented, they were indicating the time wasn’t clearly indicated as face-to-face.

So get in the habit of saying face-to-face time with the patient. Because what if there’s time where the patient’s resting on needles? I know when I go to my acupuncturist, she will put in needles. Then she usually leaves the room about 10 minutes or so. Great. It gives me time to relax. Realize though that time simply doesn’t count towards the coating, but then when she comes back, it does.

So it has to be actively part of it. So if you come back in the room and stimulate needles, it would be if you come back in and insert more, that would be an additional set. So please note here it says yes. Do you have to do insertion of needles? Yeah, reinsertion. Bad term of course, but additional insertion.

So keep in mind, just retaining needles for an extended period of time does not give two sets. Stimulating needles does not. There must be an insertion. So keep that in mind and realize I’m showing. This is from Regents Blue Cross Blue Shield from their acupuncture part. Notice it says here, eight minute rule, eight to 22, 20 23 to 37, so you can see clearly.

This is not just a SAM rule. I’m not trying to just say I’m the know it all. No, I’m giving you the rule based on the guidelines. Notice it says if you do seven minutes or less, doesn’t count. As soon as you do. Eight minutes. Yep. So right in there you can do it. So realize that UnitedHealthcare is the one I just showed you that had a problem, and it says, for any time-based code, the duration of service must be clearly documented.

And the time service is not clearly and properly documented, then the service is not supported. And it needs to be because we have to indicate face-to-face time, acupuncture. Often patient patients will rest on needles. And so the reason that we’re seeing some of this is ’cause I think we’re combining that and not separating it out or.

Just not making it clear. Just make it clear. Notice a couple of things here because it tells you how you document, so you might wonder, how do I’m supposed to document this, Sam? It’s unacceptable Documentation of time-based services. What’s unacceptable? Documenting in terms of units. You can’t just say, I did two sets of acupuncture.

You can say that, but I need you to tell me set number one, how many minutes did you spend face to face and where’d you put needles? We cannot use a range of time. You can’t say, I spent between 20 and 25. It should be, I spent 20 or 21 or 22. You also wanna make sure that you’re not specifying a measurement or increment used, meaning that I did from this time to this time.

That range part, or just not mentioning time at all. I think the easiest way to see this though, and for those of you that have been to a seminar with me and or have our accu code, you’ve seen this is a sample of a soap note. What I wanna do is just blow up. Where the area is, that time is documented.

Take a look here where it talks about acupuncture and it says Set one, two, and three. Now realize this form. If you wanted to add a force set, you just add another column, but nonetheless, notice set one. The points that were inserted or reinserted could be either one. We list the points and then we indicate face to face time five 20 to 5 45.

That’s 25 minutes notice, there’s retention time. There is a rest period, but notice set number one is 25. Notice set number 2, 5 55 to 6 0 5. That’s only 10 minutes, but does that meet the eight minute rule? Yeah, it’s more than eight plus. The first one being 25, that’s 33. We’re easily above. And then notice the third set is six 10 to six 30.

Now, may wonder how come the middle set was so much shorter? Doesn’t take that much time to add more probably. And the last set was also 20 minutes. Why was that last set longer? Think of all the things you do at the end of the visit, counseling the patient, removing the needles, and disposing. Just give me the time.

None of that is hard. Acupuncturist by, right? Always brag about how much time they spend with someone. I talked to someone this morning that goes, Sam, I spend God between 40 and 50 minutes with every patient, and I believe that to be pretty true. For most of you. You know what I want from you. Document it.

You’ll never have an issue. Now you may think I only do cash. Great. You still have to document the services. So realize this has nothing to do with insurance. This is just to do with you properly documenting what services were provided. Tell me how much time you spent, what points you did. We’re good.

It will also equal you get paid. I’m not sure you’d notice, and I’m not gonna go back to it. Did you see the prices on some of that United Healthcare? So if you wanna rewatch this later, you’re gonna go, oh my gosh. Now, I’m not saying we wanna bill that much, but if you’re in certain areas, why wouldn’t you bill what it’s actually worth?

Acupuncture is a great service. You’re at a great time to be an acupuncturist. Take advantage of the advancements of your field in getting access. Please document the time. It’ll never be an issue. I wanna say thanks, but realize we’re always here to help our network service and our seminars are where you can go for one-on-one help.

We can do zooms together and deal with you specifically, not just a general question. Please go out and do well because we’re dependent on you, the American Acupuncture Council and myself. We count on you. Your success is ours. Until next time, my friends.

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