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CPT Codes: Charting is Everything

Hey there! If you’re preparing to practice acupuncture or Eastern Medicine, it’s essential you understand Current Procedural Terminology (CPT) codes. CPT codes are an integral part of the healthcare industry and play a crucial role in accurately documenting and billing medical procedures. Understanding and effectively utilizing CPT codes is essential for proper reimbursement, effective communication, and compliance with regulations. 

So, What are CPT Codes?

CPT codes are a standardized system of medical codes developed and maintained by the American Medical Association (AMA). They are used to describe and report medical, surgical, and diagnostic services provided by healthcare professionals. CPT codes provide a uniform language that enables accurate documentation, effective communication, and proper reimbursement for medical procedures.

Scope

To start off on the right foot, let’s dive into your state’s scope of practice as a licensed acupuncturist or Eastern Medicine practitioner. 

Here’s the deal: every state has its own rules, even if there are just small differences. And trust me, those tiny variations in scope can make a big difference in what CPt codes you may use and thus, getting reimbursed or not. You might be surprised to find that some states have way more flexibility (while others are pretty strict). It all comes down to how much or how little they spell out in their statutes.

IL scope of practice for the Licensed Acupuncturist & Herbology Practice 

Let’s take Illinois (IL) as an example because that’s where I’m based. But please bear in mind, the rules can be different wherever you are. For your convenience, I have this downloadable pdf that includes the applicable scope(s) of practice in IL. I think it’s wonderful that Illinois’ includes so much for us to do!

Take the time to get familiar with the guidelines specific to your state. This way, you’ll stay within your professional boundaries, keep everything legit, and receive the right reimbursement for the awesome services you provide.

Amazing Resources You Can Use

Here are some recommended resources for CPT coding help in LAc (Licensed Acupuncturist) practices. These sources provide valuable information on billing and coding procedures:

1. Holistic Billing Services: This resource offers comprehensive guidance on billing practices specifically tailored for acupuncturists. They provide expert advice and insights to ensure accurate and efficient coding.

2. Samuel Collins DC (aka The Billing Expert): Samuel Collins is an author for the AAC (American Acupuncture Council) and serves as the director for HJ Ross. His expertise in billing for acupuncturists makes him a valuable source of knowledge. I recommend following him and exploring his webinars, where he shares valuable insights on billing practices for acupuncturists.

By combining information from Samuel Collins and other credible sources such as Holistic Billing Services, you can gather a wealth of knowledge on coding practices for acupuncturists.

Charting

Now we can get into how to best chart our visits, to optimize our results in reimbursements when we throw our CPT codes.  

Time & Location

Unattended Services

For Unattended Services, (modalities that can be performed without you having to be there for most of the time), there is no requirement that you chart the amount of time you performed it on the patient (eg. TVP lamp applied to the lumbar spine for 15 minutes). That is not to say that we shouldn’t document it. It’s best practice to just chart everything for the purpose of keeping track. But the time is not required because you will always just be billing for 1 unit of that modality; the amount billed doesn’t change if you use the heat lamp for 5 minutes or 40 minutes. So, using this example with heat therapy, there is one CPT code (97010).

The area of application (eg. TVP lamp applied to the lumbar spine for 15 minutes), however, is critical, as some insurance companies have and will deny claims when this cannot be substantiated within your case notes. If you’re treating right-sided shoulder pain and you apply heat specifically to the right shoulder, make sure to document that. It’s essential because no one will assume or infer this information on our behalf.

Other Times We Do Need To Record Time

For modalities like massage, manual manipulation, or active therapies (usually covered by the VA), time is still a critical detail that must be in your chart. The details of how you performed (or your patient performed) the therapy also must be documented. Charting a statement like “pt performed active therapy to increase range of motion” is not sufficient. What kind of active therapy? How many times? How long? Why? By the same token, recording the time spent as ” pt performed 1 unit of therapeutic exercise to increase range of motion in the right knee” is also insufficient and will likely be denied. Be sure to hit the points that actually define the CPT code your using. For the code (active therapy), the definition states:

One or more areas, each 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with one-on-one patient contact”.

“Acupuncture CPT Codes | 97810 CPT Code & More | HBS.” Holistic Billing Services, holisticbillingservices.com/acupuncture-cpt-codes-insurance-billing/#:~:text=Code%3A%2097026. Accessed 2023.

Make sure you cover all those bases that it outlined for you, by explaining what you did, why you did it, that you were in one-on-one contact with the patient, and for how long.

My tip is to document your actual start/stop time of that modality. If you are an “estimator”, I should warn you that it is simply in our nature to round things. Our perception of our time spent is often not truly the time we spent, so someone is getting cut an unfair deal. It benefits us in either getting paid for all the time we’re spending or in strong patient retention practices. Both are a win.

Type & Intensity

There are instances where we select a CPT code for modalities that involve selecting and adjusting specific settings, such as electrical stimulation, cold laser therapy, or heat therapies. In these cases, it is important to document the type of setting, and what it was set to, during the treatment(eg. intensities, frequencies, wavelengths, and so on). This documentation not only supports accurate billing but also ensures better continuity of care if another practitioner needs to review the patient’s chart in the future.

What’s the Difference?

Sometimes charting will mean all the difference between two CPT codes. Take CPT code 97124 – Massage versus CPT code 97140 – Manual Therapy. If you select one of these codes to submit, your documentation should support one over the other. Perhaps only one of these would be covered, so it may be important that you show how you performed manual therapy and not massage. You could use CPT code 97140 and support that by charting on the day of treatment that you provided Direct one-on-one manual therapy service- and go on to briefly describe it: “Focused myofascial release on the plantar surface of the right foot was performed for 15 minutes; pressure to patient’s threshold was restrained to a moderate level” would be supportive for you, as it demonstrates you met the CPT criteria:

“Techniques like mobilization and manipulation, manual lymphatic drainage, and manual traction; one or more regions, each 15 minutes with one-on-one patient contact”

“Acupuncture CPT Codes | 97810 CPT Code & More | HBS.” Holistic Billing Services, holisticbillingservices.com/acupuncture-cpt-codes-insurance-billing/#:~:text=Code%3A%2097026. Accessed 2023.

To Sum It Up

Always chart:

  • Time & Location
  • Time of Application
  • Type & Intensity

Provide as much detail as you can- you never get in trouble for too much. Remember, “If you don’t chart it, then it never happened”

In conclusion, I wish you good health and happiness! 🌼

I hope this article provided some helpful insights, and I encourage you to explore my other articles on billing if you found this one enjoyable. Stay well and happy, and thank you for reading!

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