Acupuncture insurance billing with ICD-10 diagnosis codes begins in October. The deadline is here. All insurance billing starting on that date must use the new ICD-10 system of diagnosis billing codes. At the Healthcare Medicine Institute, we have provided free resources to help with the transition plus an acupuncture CEU / PDA course on the topic.
The acting administrator of the Department of Health & Human Services notes, “If you don’t use a valid ICD-10 code starting on October 1, 2015, you will not be able to successfully bill for your services.” This includes billing private insurance companies and Medicare. In a fact document released by the Centers for Medicare & Medicaid Services (CMS), medical professionals are given the following instructions for denied insurance claims, “Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.”
Billing Medicare may be more flexible in the first 12 months than billing some private insurers. The CMS notes that “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes.” They add, “Each commercial payer will have to determine whether it will offer similar audit flexibilities.”
Specificity requirements may cause some initial payment reimbursement issues for licensed acupuncturists. For example, if an acupuncturist bills M79.603, which is the code for unspecified arm pain, the insurer may deny the claim and request a code specifying laterality. As a result, the acupuncturist must resubmit with either the M79.601 right arm pain code or the M79.602 left arm pain code. The specificity requirements are determined by each insurer. At the Healthcare Medicine Institute, we provide a list of usable codes for acupuncturists and go over the basics of what to expect in the acupuncture continuing education CEU course entitled Acupuncture Insurance Billing #1.
Acupuncturists and physicians will know whether or not to rebill an insurance claim from the information provided on the EOB, Explanation of Benefits. This form is sent to patients and providers with explanations of payments and non-payments for treatments and services. The EOB will flag outdated ICD-9 codes, request greater specificity, or outright deny the billed code because it is not a covered benefit.
Acupuncturists and their billers will be busy changing codes. The good news is that CPT (Current Procedural Terminology) codes will not be changing. The following codes remain the same:
- 97810: Manual acupuncture, initial 15 minutes.
- 97811: Manual acupuncture, each additional 15 minutes.
- 97813: Electroacupuncture, initial 15 minutes.
- 97814: Electroacupuncture, each additional 15 minutes.
The same is true for physical medicine codes and evaluation and management codes. There is no immediate change to the CPT codes, only the diagnosis codes are changing.
In related news, acupuncturists will see changes to their state CEU and NCCAOM® PDA requirements. One important change for NCCAOM® Diplomates is that the four hour safety and/or ethics requirement changes to a two hour safety and a two hour ethics requirement. At HealthCMi, we provide valuable acupuncture continuing education courses that fulfill these new requirements. CPR certification will also be required above and beyond the four year, sixty hour PDA requirement. American Heart Association (AHA) and American Red Cross certification courses fulfill the CPR requirement.
States are also updating their requirements. For example, the California Acupuncture Board will be adding an ethics requirement for CEUs. HealthCMi will post the final determinations concerning this new requirement and all other state changes as they are finalized.