CPT (Current Procedural Terminology) codes are a crucial component in healthcare billing and insurance processes. For acupuncture practices, accurate coding ensures that practitioners are reimbursed properly for the services they provide. One of the key codes for acupuncture treatment is CPT 97814, which is used for acupuncture services. This guide will provide a detailed explanation of what CPT code 97814 covers, how it should be used, and best practices for billing and coding in acupuncture practices.
CPT Code 97814 Description
CPT Code 97814 refers specifically to acupuncture services provided by an acupuncturist. It is used for the initial 15 minutes of acupuncture treatment, where the acupuncture provider uses needles for the therapeutic management of the patient. This code is part of a series of codes used in acupuncture, and it is meant to capture time-based procedures where direct face-to-face interaction with the patient occurs.
CPT 97814 specifically covers:
- Acupuncture: The use of needles inserted into specific points on the body for therapeutic purposes.
- Duration: It is specifically for the first 15 minutes of treatment.
- Procedure: The provider must be licensed and trained in acupuncture to use this code.
CPT Code 97814 Definition
According to CMS, 97814 acupuncture code is 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure.)
When to Use CPT Code 97814?
- Initial Treatment Session: 97814 CPT Code is used for the first 15 minutes of a treatment session. If the session lasts longer than 15 minutes, additional codes (e.g., CPT 97813 or 97815) may be used to represent the extended time.
- New Patients: This code may be used for new patients who are receiving their first acupuncture session.
- Follow-up Sessions: In some cases, 97814 can be used for follow-up sessions if the treatment duration is under 15 minutes. If treatment lasts more than 15 minutes, additional time-based codes should be used.
Let’s consider the example of a chiropractor treating a new patient for acute pain using acupuncture:
- The patient is seen for the first time and is undergoing an acupuncture session for 12 minutes.
- The chiropractor uses 97814 billing code to bill for the initial 15-minute acupuncture treatment.
- The chiropractor documents the specific acupuncture points used and the therapeutic purpose of the treatment.
- If the treatment session lasts longer (e.g., 30 minutes), the chiropractor would also use CPT 97815 to account for the additional time spent.
How to Use 97814 Acupuncture Code
To ensure accurate billing and 97814 CPT code reimbursement, the following steps should be taken when using this code:
1. Identify the Type of Service Provided: Ensure the patient receives acupuncture treatment and that the session lasts 15 minutes or less. This code applies only to acupuncture and does not cover other services like dry needling or electro-acupuncture.
2. Verify Patient’s Insurance Coverage: Some insurance plans may have specific guidelines for acupuncture treatments, including whether or not acupuncture is covered. Check the patient’s insurance plan to ensure that acupuncture services will be reimbursed.
3. Document the Service: Documentation should reflect the time spent, type of service, and specific acupuncture points treated. This will help ensure that insurance claims are processed smoothly.
4. Use Additional Codes If Needed: If the session lasts longer than 15 minutes, you may need to use additional CPT codes. CPT 97813 or 97815 may be applicable depending on the duration of the service.
Understanding Related CPT Codes for Acupuncture
- CPT Code 97813: Acupuncture, with electrical stimulation; first 15 minutes. 97813 code is used when electrical stimulation is applied in addition to traditional acupuncture techniques.
- CPT Code 97815: Acupuncture, without electrical stimulation; each additional 15 minutes. This code is used for any time over the initial 15-minute period and should be used for each additional 15 minutes of service.
Best Practices for Billing CPT 97814
1. Accurate Time Documentation: Always keep accurate records of the time spent performing acupuncture. This includes documenting the start and end time of the session to justify the use of 97814 CPT
2. Patient History: Ensure that patient history and treatment plans are properly documented to show the medical necessity of the acupuncture service.
3. Service Detail: Include details on the acupuncture points used during the treatment, the technique applied, and any special techniques like electro-acupuncture.
4. Modifier Codes: Depending on the situation, you may need to add modifier codes to your billing (such as Modifier 25 for a separate and identifiable procedure). Modifier codes can help clarify that acupuncture was performed separately from other treatments.
5. Insurance Verification: Verify insurance coverage before the treatment to ensure that the patient’s plan covers acupuncture services. This also allows you to be aware of any specific restrictions or requirements the payer may have.
6. Documentation of Medical Necessity: Keep a well-documented record that justifies the need for acupuncture, especially for chronic pain, musculoskeletal disorders, or other common indications for acupuncture.
7. Acupuncture Software: Using acupuncture software can streamline the documentation and claim process by automatically recording treatment details, ensuring accurate claim submission, and facilitating faster reimbursements. This reduces the risk of errors and helps ensure compliance with billing and insurance requirements.
Common Mistakes to Avoid
- Overbilling or Underbilling: Avoid overbilling by ensuring that time-based codes are properly matched to the treatment time. Similarly, ensure that underbilling doesn’t occur by using only the 97814 code for sessions that last longer than 15 minutes.
- Misuse of Acupuncture Codes: Ensure that you are using the correct code for acupuncture treatments. For example, using 97814 acupuncture code for a treatment lasting 30 minutes would be incorrect, as the code applies only to the first 15 minutes.
- Failure to Document Appropriately: Failing to document acupuncture techniques, time spent, and medical necessity could lead to claim denials or audits from insurance companies.
- Using 97814 for Non-Acupuncture Services: Ensure that CPT 97814 is only used for acupuncture. If the treatment provided is not acupuncture, use the appropriate code.
Reimbursement Rates for CPT Code 97814
Reimbursement rates for CPT code 97814 vary depending on the payer, geographical location, and specific insurance plan.
Generally, reimbursement for acupuncture services can be lower than for other medical services. However, it is essential to submit accurate claims, as proper coding and documentation can increase the likelihood of timely and full reimbursement.
To find the exact reimbursement rate for your practice, it’s important to verify with the patient’s insurance provider or refer to regional Medicare and Medicaid fee schedules.
The Centers for Medicare & Medicaid Services (CMS) and other third-party payers offer detailed information on reimbursement rates for acupuncture.
Related CPT Codes
In addition to the primary acupuncture codes such as 97810, 97811, 97813, several other CPT codes may be relevant when acupuncture treatments are part of a broader therapy plan. These codes help describe additional services or evaluations provided during the patient’s treatment. Here are some related CPT codes:
- 99201 – Office or outpatient visit for the evaluation and management of a new patient, requiring a medically appropriate history and/or examination and straightforward medical decision-making.
- 99202 – Office or outpatient visit for the evaluation and management of a new patient, requiring a medically appropriate history and/or examination and straightforward medical decision-making.
- 99203 – Office or outpatient visit for the evaluation and management of a new patient, requiring a medically appropriate history and/or examination and moderate level of medical decision-making.
- 99204 – Office or outpatient visit for the evaluation and management of a new patient, requiring a medically appropriate history and/or examination and moderate to high level of medical decision-making.
- 99211 – Office or outpatient visit for the evaluation and management of an established patient, which may not require the presence of a physician or other qualified healthcare professional.
- 99212 – Office or outpatient visit for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and straightforward medical decision-making.
- 99213 – Office or outpatient visit for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and low level of medical decision-making.
- 99214 – Office or outpatient visit for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and moderate level of medical decision-making.
- 97140 – Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.
These codes can be useful when combining acupuncture with other therapies or when providing evaluation and management services alongside acupuncture treatment. Properly using the correct codes ensures accurate billing and reimbursement.
Conclusion
Understanding and using CPT code 97814 correctly is vital for acupuncture practitioners seeking to ensure they are reimbursed for their services. Proper documentation, adherence to time-based coding, and an understanding of related codes will ensure that your acupuncture practice remains HIPAA-compliant and financially healthy.
zHealth managed billing services and acupuncture software can significantly simplify this process by offering tailored solutions specifically for your acupuncture clinic.
With features that streamline billing, coding, and documentation, zHealth ensures that you correctly use CPT codes like 97814 and other relevant modifiers.
Our software can automate the tracking of time spent during treatments, ensuring that all necessary details are recorded accurately for proper reimbursement.
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