However. Let’s talk about what’s going on now. I CD 10 for 2026. What has happened? As they do every single year. October 1st, there’s some new codes.

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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.

Greetings to all my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture for you, your practice, and of course for the American Acupuncture Council. Always wanna make sure that you’re getting paid correctly and to the fullest extent. To make sure that’s gonna happen.

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What is gonna happen coming up? Here’s a riddle. When do the 2026 diagnosis begin? When do they start? You may be thinking 2026 Sam. Not so fast my friends, the 2026 diagnosis codes will update October 1st. So let’s go to the slides. Let’s talk about what’s going on, obviously, and I hope that you’re aware that diagnosis codes, when they update and they update yearly, always update on October 1st.

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In fact, right now is the 10 year anniversary of ICD 10, and so it’s exciting to think wow. It’s been 10 years, so I want everyone to recall. Remember when ICD 10 came, I CD 10 came about and people lost their mind thinking, what the world’s gonna go off? No, it was all fine. In fact, for acupuncturists, I’m excited because you are going to be getting something called ICD 11.

I’m hoping it’s implemented sooner than later because there’s gonna be specific coding directly for acupuncture providers. Are traditional medicine in their descriptions, so it means you’ll be able to code cheese, stagnations, different types of patterns and all other things related to traditional medicine, which just gives a little more granularity of severity.

We’re not there yet, but we’re getting close, so pay attention next year’s seminars. I will deal with that. However. Let’s talk about what’s going on now. I CD 10 for 2026. What has happened? As they do every single year. October 1st, there’s some new codes. This year is no different. In fact, there are now 74,719 diagnosis codes.

And you may think, oh my God, that’s a lot of codes. Are you ever gonna use those, all those codes? Of course not, no. DR. Will, however, realize, keep in mind, we do need to make sure if there’s changes, are there specific to codes we use By example, this year it’s a lot of new codes, 487 new codes. 28 codes were deleted and then 38 revisions, and you’re thinking, Ooh, let’s be careful.

I’m always going to be for you and for our profession, very acentric, I care about the things that are specific to what we do. So by example, let me show you just a little bit of a list of all the codes that have updated and you’ll see here, whoa, malignant inflammatory neoplasm of the breast. And of course these are codes.

You look at this and go Sam I don’t think I’d ever use those. And I would say, you’re probably correct. You can see here primary apraxia of speech, multiple sclerosis. Now, a patient with multiple sclerosis may indeed. Be a patient of yours, but are you treating the multiple sclerosis or treating the symptoms?

Multiple sclerosis would likely just be the comorbidity. So let’s get into what are we doing that is specific to what you do. Now, here’s an important code like last year. Remember if you look at, there were some new codes for disc for the lumbar spine, though they were important. I bet. How many of you used any of those codes this year?

Probably none, but these are some, I think you might. Some of you are probably in likely coding pain codes, specifically pelvic or peroneal pain. The old code is R 10.2, but let me be careful when I say old code. That means as of October 1st, so by example, if you’re treating someone in September or before for pelvic or peroneal pain, you will continue to code R 10.2 for any date of service that was in September or earlier.

Once the data service is after October 1st, then you may begin using the new codes and here they are. So the new codes just get a little bit more specificity. Of course, there’s just the generic unspecified, which is fine, but my hope is when someone has pelvic or peroneal pain, you can identify what part of the pelvis is it?

Is it on the right side? On the left side, is it on both sides or is it more in the pubic area? This allows you to have more specificity and realize pain is gonna be one of the more common things you’re paid for. Certainly this is gonna be one that you add into your arsenal. In addition, there was some deletions of other codes or a deletion of a code here.

Also, the contusion of an abdominal wall. And you might think come on Sam I’m not gonna deal with that. You might, particularly for those of you who deal with personal injury claims, it’s very common. To have injuries to the abdomen from the seatbelt. So now we’re gonna have three new codes, contusion of the abdominal wall.

Then more specifically to the groin and to the flank. So it allows you like if the seatbelt’s going lower across the chest. Now I do wanna highlight, I hope you’re all noticing, I’m only using the A designation for this sprain strain or contusion code that A is indicating the initial visit. And it also indicates all visits with active care, which means that’s the one you’re commonly gonna use.

However, let’s say someone had a contusion and it’s six months old. That’s when you would use the S or the sequelae where there’s residuals. I think the important thing here is just making sure if you have been, or thinking you may be using contusion based on trauma, it’s updated when it comes to abdominal.

Another update here is again, some common pain codes for abdominal pain. Now, there is a code still you can save from multiple sites, and they’ve always had the quadrants, but now they’re getting more to flank and it’s not pain. Notice it’s going to be tenderness. Part of it, but then you’ll notice there’s also codes specific to pain.

So what’s the difference? Tenderness means that upon palpation, it’s tender. Where is pain is whether you palpate or not. There’s pain. I’ve put a little chart here too of what each of those mean, but the point will be if you’re using codes for abdominal pain, there has been some updates. So make sure you update your list.

This is again, those ones for the contusion. Make sure you’ve updated those again, contusions happen. And keep in mind, there’s some other ones. You’re gonna go well. Sam, I don’t know if I use this one. I doubt it. And here’s my point. Sometimes codes update of varus deformity or myositis. O Ossific hands.

Think of it. If someone has myositis o ossific hands in the upper shoulder, which means that’s the bone. What’s gonna be their symptom pain in the upper arm? So that’s probably the more likely code. The same would apply with cost of vertebral tenderness. If someone has cost of vertebral tenderness, that’s a symptom.

What is that probably gonna mean? Cost of vertebral is part of thoracic spine. I would argue that’s gonna be M 54 6. So keep in mind, it’s always nothing wrong with being specific to your profession because by example, I brought up the one for multiple sclerosis already. But are we gonna treat that directly?

There is a bunch of new codes. Are those gonna be ones you commonly use? I do not think so. So what I’m gonna say is just be conscientious of diagnosis, severity, specificity. Don’t throw spaghetti at the wall and do all types of codes. One of the things that I focus on at our seminars and with my network members is making sure you’re using the codes that are payable by insurance.

So network members expect from me, you’re gonna get a nice list because the best practice of coding. Is always gonna be giving me something about the pain, the symptoms, the signs, and there’s other codes that have within that. But what do each one pay? Get that list. That’s one for Aetna, for Cigna, what I’m gonna say is.

Let me be your advocate. Help me help you. We not only do programs like this for you that don’t cost anything, but we also do tons of seminars and other one-on-one with you to make sure your office is up to date. Again, network members expect from me, you’re getting your email with all the updates for everyone else.

I hope you be part. In fact, if you look coming this Saturday, or excuse me, Sunday for acupuncture, we’ll be doing a whole coding and update seminar. But until then, fr friends, I wish you well and see you next time.

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Let’s talk about what’s going on with recoupment and standard episode of care specific to acupuncturist and frankly non-physician providers.

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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.

Greetings, friends and colleagues. It’s Sam Collins, the coding and billing expert for acupuncture, the profession, of course, the American Acupuncture Council. Of course, I’ve got a little update coming up because obviously many of you have been contacting me, network members, and even others have contacted me.

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Say, Hey, Sam, what’s going on? I notice. That they’re not paying for exams and they’re also still recouping. We’re gonna talk a little bit about that, but we have to update from what we did in April. So let’s go to the slides. Let’s talk about what’s going on with recoupment and standard episode of care specific to acupuncturist and frankly non-physician providers.

So you’ll see here is a letter dated June 23rd from Tri West, and it says, we received the above claim. Let me bring it so I can pull it up. And it says. Try West. Receive the above-mentioned claim for your often notice I highlighted in yet it says evaluation and management procedure codes are not paid for this rendering provider specialty.

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This is the latest thing we’re seeing. It appears, and I’ve seen it absolutely published way that to me would make it more, but it appears they have taken the ability for acupuncturists to be. Separate exams when it comes to the va. That of course is very frustrating because of course is an exam necessary thing.

Of course, I to determine the need for care you to determine the continuation of care. So what’s occurring, I think is maybe A-D-O-G-E cut here that they’re eliminating the payment for exams. That doesn’t mean you don’t need do one, they’re just not. For it. I think it’s probably we’re seeing the patient for the overall payments, but they’re not covering it.

We’ll see directly. Now the word that they did this in ap, what I’ve seen Pub in their newsletter is not quite clear enough for me. So I’m waiting to see the full publishing and episode of care, but I’m sure many of you have met. Now. Here’s gonna be the pushback if the exam after April when they published it.

They’re gonna be damn behind it because published, however. But then I want you all to think of standard episode of Care for Acup Occupy. Whenever you notice the standard episode of care, you’ll notice whether it’s going to be initial chronic follow-ups. They include e and M codes. You’ll see really, 9 9 0 2 to 2 0 5 9 9 2 1 to 2 1 5, and I bet probably your authorization as well.

So my argument’s gonna be, they’re saying they’re not gonna cut well if it’s after April, send an updated authorization’s not listed. I’m waiting to see that, then I would say, okay, but if it’s prior dispute’s gonna be, how did you send me an authorization? Clearly indicates exams and they’re, now, I’m not gonna pay for it now, it appears after April.

This is gonna true. But prior, it’s gonna be a pushback. Now that very frustrating. Of course it is. But I’m gonna ask you, is it worth it to still be part of it? I do, because think of the overall payment on a VA patient. You’re getting 12 visits to start, probably eight and eight to follow up. Assuming you’re doing three sets of acupuncture and a therapy or two, that’s maybe 110 to $150 of reimbursement.

Am I going to take away potentially, three to $4,000 a payment? Because they’re not gonna pay for a couple of exams. I prefer they do, but I’m gonna say I’m not gonna go that far. It’s something I think though we’re gonna be fighting. I shouldn’t say think. I know we’re gonna be fighting as a profession on a national level along with chiropractors and physical therapists, because this affects them too.

Because this goes against the equality provision. Equality says that if it’s within scope and you pay, other providers have to pay you because this is not Medicare. Now that’s gonna be a little bit of a fight, and that’s not gonna happen in short term. So when you get this, I do think we should dispute it.

I would certainly push back if it were pre-AP April, that they should, if it’s after April, not so much. Of course, if you’re a network member with me, reach out. We’ve got some letters for that as well. But I do wanna highlight also beyond that, just a couple of quick updates. Let’s talk about what’s happening and what’s gone on with doing.

Things with 9 7 0 3 9 or 1 3 9, and that’s of course what a lot of offices have used for cupping. Remember that was removed more than a year ago, so please do not use that code for cupping. It is not appropriate. Do not list it. They may pay it, but they’re gonna recoup it. So do not, if you’re gonna do cupping, use 9 7 0 1 6, which is a vaso pneumatic device.

It’s not a high payer. It’s about 11 to $15, but at least you are being paid for it. But again, do not use 9 7 0 3 9 and if they are recouping that, if it’s pre 2024. I would argue they can’t, but if it’s after 2024, they can. Now some people have argued. What about statute of limitations? Statute of limitations, I would argue certainly does apply.

Unfortunately, you know what I’ve realized or what I’ve learned, the statute of limitations for the VA is actually six years, so we’re not gonna win on that one as far as this goes. The other thing here is, and this has come up recently because obviously a lot of you are using paint indexes or similar.

To verify how the patient’s improving. I recently had an office, or actually a few that they were denied few further care because they weren’t showing at least a seven point difference on the general pain index. I really like the general pain index. It’s certainly the similar to the pain interference.

Make sure though, if you’re using it. If you’re doing it once a month, there’s gotta be at least a seven point change to be considered significant. Now, most of you, I hope, are getting bigger than seven point changes, frankly, but if you’re not realize it’s going to be a problem ’cause they’re gonna push back, which means you also have to focus in what if I’m using the pain scale?

That also has a limitation, which means it’s gotta be three points or more. Obviously if I say I’m a seven, I go to a six. That means I’m better, but it’s not considered significant. So if they start at seven, the next time you do it to really be considered significant, say on re-exam, it’s gotta be four.

So a three point difference, I would say. Then obviously those two factors are important. If you’re not getting at least seven or three, you better focus in on something about an activity, particularly a home or work activity that couldn’t do before. What they care about is the patient getting better.

Because remember, once they’re stabilized, they have to be on a continua care with flare up. So keep in mind, Acture works well. We need to demonstrate it. Show me on this general index pain scale or function, how much improvement there is. Now this brings me to, for some of you, and I’ve had this question a lot, is being part of the VA worth it?

Does it cost anything to join? No. Do the patients sometimes have some hassles getting authorization? Yes, that’s true. But when you’re paid. Let’s go over it. If you’re getting a standard episode of care for 12 and eight visits, just say the first two 20 visits in a year, considering just the treatment, that’s probably 2000 to $2,500 now, even with taking out exams.

Is that worth it to me? Absolutely. However, am I frustrated with the exam part not being paid? I. But at the same token, that’s not gonna stop me, but this is where if you’re not part of your state and national association, this is where we need to belong. ’cause this is where we need to push back because how are they treating us differently?

Now the downside is they are doing it to chiropractors. To physical therapists as well as massage therapists. So it’s not just you. But at the same token, I think it’s valid to say that it should be covered. ’cause how are you supposed to determine care without an exam because they’re doing this based on a Medicare rule?

Medicare only sets the fees for the va. It’s not the protocol. ’cause if that were true, they shouldn’t pay for acupuncture at all unless it were chronic low back pain. And under supervision, so we know that they’re just choosing and picking certain ones. So I think we’re gonna have a pretty good pushback.

But I do still, it is worth it if you’re thinking, I’m not so sure. We are doing next month in August. A whole seminar on the va, what to do, how to make it work for you, make sure you tune into that. Otherwise, I’m gonna say to everyone, we always wanna be resource. If you’re having issues, reach out to our Connect Acupuncture council.

The next specifically, we highlight updates right on our website. And if you’re a member, it allows you to have direct interaction with me via calls and zooms. And otherwise, until next time to our friend, be well.

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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.

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The one I want to give an example to is, one that’s come up quite a bit recently is what is the difference between 9 7 1 1 0 and 9 7 5 3 0.

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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.

Greetings, friends and colleagues. This is Sam Collins, your coding and billing expert for acupuncture. The Profession, acupuncture network of course, and the American Acupuncture Council here to always make sure you have the best and latest information. And one of the things I run into all the time in teaching seminars, but also acting as an expert, is trying to understand what are the differences between certain types of CPT codes.

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The one I want to give an example to is, one that’s come up quite a bit recently is what is the difference between 9 7 1 1 0? 9 7 5 3 0. So let’s go to the slides. Let’s talk about it. What are these two codes? 9, 7 1, 1 0 is exercise, therapeutic exercise 9 7 5 3 0 is therapeutic activities. What is the difference?

How do we understand that? I wanna make sure acupuncturists have a clear understanding, ’cause that certainly can be within scope. Let’s first get into, we have to always make sure we understand the codes well, to choose the right service. Based on the right code, based on the services we’re providing.

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So it says here per CPT that select the CPT code of the procedure or service that accurately identifies the procedure or service performed. Do not select a CPT code that merely approximated. So you can’t say it’s like it. Like I had someone that found out that hot packs aren’t payable by almost all insurances and haven’t been for quite some time.

So he said I’m going to bill hot packs. Infrared heat with the idea being, theoretically any warm body. Emits an infrared portion of the heat spectrum to some degree. That’s not really the intent. Certainly infrared heat is a little bit beyond just a hot pack. So again, we want to be careful of trying to twist things.

If it doesn’t fit exactly, make sure you’re using an unlisted code, which pretty much means it’s not gonna be paid, but use the code that best identifies it. Here we have to remember as an acupuncturist. Can you do more than just deliver acupuncture? Of course, your scope of practice often can be very broad, and I will say certainly look at your state.

If I teach in your state, certainly get a hold of me. We can work on that. Understanding what type of services you can do beyond obviously evaluations, but you’ll often see in your scope it’ll say adjunctive services. The adjunctive services often are very broad. It includes a lot of physical medicine services that might include heat, massage, exercise, and so on.

So do verify your scope. But generally all physical medicine services are generally within scope done with the idea of a traditional medicine slant to it. So let’s take a look specifically at two codes here today. 9 7 1 1 0. You’ll notice as a therapeutic procedure, one or more areas 15 minutes, which means it’s face-to-face time, just like acupuncture and therapeutic exercise Says therapeutic exercise is to develop strength and endurance, range of motion and flexibility.

Okay, so the standard things you do, if you told someone to go out and exercise, what would they think they’re going to improve? I think that’s what we’re seeing with that. Pretty generic, Qigong, if you will, but what about a therapeutic activity? Now you’ll notice the one in the bottom, 9, 7, 5, 3 0 says therapeutic activities, direct one-on-one patient contact by the provider.

So that’s still the same, have to be there. But then it says, use of dynamic activities to improve functional performance. Therein is probably the biggest difference. Exercises generically just to increase strength, flexibility. Therapeutic activities are exercises, but specifically done to create a certain or specific functional outcome.

So 9 7 1 1 0 are movements and physical activities designed to restore function and flexibility. Okay, it. It includes instruction and feedback. So realize when you’re doing this face-to-face, it doesn’t necessarily mean that you’re staring at the person touching them, but you’re supervising, making sure they’re doing it properly, safely, maybe assisting them.

But it does require you be one-on-one. You cannot do exercise with two people at the same time. They can be doing that, but it wouldn’t be this code 9 7 1 1 0 is one-on-one. When you’re with a patient, maybe they’re doing yoga poses, maybe they’re doing tai chi or any type of exercise for strength, flexibility, endurance.

In fact, if you think of exercise generically, it fits almost everything we think of when you go to the gym. Bikes and treadmills, gym equipment, weight equipment, isometric, isotonic, isokinetic, but includes passive things like stretching. Might be assisting the person just in stretching.

So certainly any of that fits. Just make sure you’re documenting what exercises I. How much time you’re spending in doing it. So simple things like knee to chest stretching, maybe a low back rotational stretch, anything like that certainly fits. Notice. These are ones that you might be directing the patient to do.

Now this might be one we probably give them to do it more at home later, but certainly when they’re doing this in the office with you, that is absolutely a billable service. Now, what is the difference of 9, 7, 5, 3 0 exercise? I think we can see pretty easy and straightforward, however. 9 7 5 3 0 says one-on-one patient to improve functional performance.

So this involves functional activities, bending, reaching overhead activities with very specific outcomes to increase a function. So let’s say by example, you had a person that is a grocery store clerk and they hurt their wrist. When you strengthen that wrist, is it just to strengthen or is it to strengthen it to have specific tasks to allow them to do their job at the grocery store?

The same exercise that might be for someone just to strengthen the wrist generically, may be the same for the grocery clerk, but because you’re specifically liking to do a specific task, whether it’s going to be reaching in and out of a bag and lifting items, makes it more an activity. So always think of the outcome, realize all exercises.

Could be therapeutic activities. All therapeutic activities potentially could fit under exercise, depends on the why. So here’s the best way to think of it in choosing it. Look at all these pictures on the right. Could you say to me, oh, Sam, that one is exercise. This one’s a therapeutic activity. We cannot tell from the picture because choosing the code depends on the intent of the task.

So follow me here. If you’re doing abdominal curls, they certainly can be used to strengthen weak abdominal muscles and build as exercise. They come in their stomach muscles are weak. We’re doing abdominal curl strength in the stomach. Great. However, what if the patient is performing the abdominal corals specifically because their abdomen is so weak, they don’t have an ability to rise up from a lying down position or get out of a chair because the stomach is too weak.

Now all of a sudden. Those exercises, yes, they’re strengthening the stomach, but it’s there because we need an outcome that it’s there to perform. Getting in and out of a chair or lying down, that’s the activity and that’s why this is worth more. To give an example, 9 7 1 1 0 has a RVU of about 0.89.

Compared to 9 7 1 9 7 5 3 0, which is 1.15. So you’re gonna see that’s almost a 30% difference. It’s worth quite a bit more because this is designed specifically for that patient, something for them to do, not just generic for everyone. If everyone does the same thing, I’m gonna say, ah, that’s probably exercise.

But best practices determine what is the outcome expected from the task. Is it simply just to strengthen? Or is it a functional performance? When it becomes a functional performance, realize the higher value is you’re designing something specific for this patient’s needs. And I think when you think of most exercises, I think that’s what we do.

Now, obviously if everyone gets the same sheet, the same things, okay? But assuming we’re gonna have some nuanced differences, I think it’s far better to look to make sure we’re choosing the right one, because certainly one is worth quite a bit more. And I want you to be paid what you’re worth. Don’t be afraid to code what you’re doing so long as you document it properly, I will always support you.

That’s what we do at the American Acupuncture Council and the network. To differentiate things. Make sure you have the right resources. That’s what our network does. You’ve been to our seminars, but have you ever thought of, Hey, let’s have an expert on task. I could be part of that. Join our network. We’re with you one-on-one, and you get all our seminars free.

Till next time, my friends, I wish you the best.

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