Exams and re-exams must be documented as separate and distinct from the pre and post-service evaluation associated with acupuncture.
The acupuncture codes indicate the time is 15 minutes of face to face with insertion or “reinsertion” for the additional sets. Note the reinsertion should be seen as additional insertion as you would not “reinsert” needles but would insert a new needle. While you did note you spent 50 minutes you did not indicate how that time was spent. Was it face-to-face time doing an active part of the acupuncture service or examination or was it time the patient was resting on needles?
Note indicating that 50 minutes of “treatment” does not provide any specificity of how the time was spent whether for the acupuncture or exam.
The 15-minute increment of time is defined as personal one-on-one contact with the patient. This means that the acupuncturist is in the room with the patient, and is actively performing a medically necessary activity that is a component of acupuncture or electroacupuncture, this would include a review of history, day to day evaluation, hand washing, choosing and cleaning points, inserting and manipulating needles, removal, disposal as well as completion of the chart notes while the patient is present. The time that the needles are retained is specifically excluded to determine the time and consequently from reimbursement.
Review your documentation to see how time is defined and how was it indicated for each set. Acupuncture is a 15-minute code and per the 8-minute rule for timed services in the Current Procedural Terminology (CPT) it is possible for the face-to-face time for one set to be as little as 8 minutes.
For services billed in 15-minute units, count the minutes of skilled treatment provided. Only direct, face-to-face time with the patient is considered for timed codes.
- 7 minutes or less of a single service is not billable.
- 8 minutes or more of a single service is billable as 1 unit or an additional unit if the prior units were each furnished for a full one.
1 unit (set) must include a minimum of 8 minutes face to face time with insertion (8-22 minutes = 1 unit)
2 units (sets) must be at least 23 minutes of face-to-face time. The minimum time for any set must be 8 minutes and the first set could be 15 minutes followed by 8 minutes for the second set. Any combination that meets 23 minutes with no single set less than 8 minutes would qualify. For example, it would be possible for the first set to be 11 minutes and the second set 12 minutes (23-37 = 2 units)
3 units (sets) must be at least 38 minutes face-to-face (38-52 = 3 units)
4 units (sets) must be at least 53 minutes face-to-face (53-67 = 4 units)
The above examples would also include additional insertion of needle(s)
For an examination consider the following; evaluation and management (E&M) codes may be billed if and when there is a separate and distinct evaluation that is above the day-to-day evaluation associated with acupuncture. The typical review of history and how the patient’s condition is changing is considered integral. As would evaluation of the area of care which may include inspection, palpation, ranges of motion, tongue pulse, etc.
Note an E&M is appropriate approximately every 30 days for an ongoing care plan. Unless there was a new injury or complaint or some substantial change any sooner than 30 days is not reasonable.
Further, the evaluation that is required for an E&M would constitute a full re-exam including how the patient has changed since the initial date of care along with a complete evaluation that would compare all the original exam elements. There would be an updated care plan and goals as well. Do not simply state it is a “re-exam” when the notes do not dictate a complete evaluation and not simply a statement of such withthe same day-to-day evaluation.