December 2015 Newsletter

Table of Contents - December 2015    

Billing Medicare: Yes, You Can!

I am frequently asked whether it is “legal” for a physician acupuncturist to bill Medicare for evaluation and management (E&M) during an office visit when the physician also performed acupuncture.    

The answer is settled law — YES — and your AAMA expended considerable time and energy to obtain that answer.   

In a definitive statement, Medicare explains: Medicare will pay for the evaluation and management (E&M) portion of an office visit even if   acupuncture, a non-covered service, is performed during the same visit, if certain specific conditions are met.   

The facts leading to this conclusion arose from a personal situation. A new patient of mine, after signing a statement clearly stating Medicare billing rules and my office policies, personally paid for the acupuncture service, and I billed Medicare for the E&M per the signed statement. In spite of my clear billing explanation, the patient demanded a refund, stating that I was paid by Medicare for the E&M and he should have received that payment, not I.   

After reviewing my office progress notes, Medicare requested reimbursement of the monies paid to me for E&M services. Their stated position, at the time, was that any services performed with acupuncture during the same office visit were non-compensable. I requested a hearing on the matter before a Medicare hearing officer and I received a fully favorable Hearing Decision.   

My argument rested on one specific paragraph from the Medicare Report dated March 1997: Additionally, any other services billed on the same date of service as acupuncture services, e.g., evaluation and management services, are not covered when they are related to the acupuncture services. The other services must be medically reasonable and necessary for the patient's medical condition and not related solely to the acupuncture services. In such a case, it would be expected that the separately billed service would be distinctly recorded and documented in the patient's medical record and available to the carrier for review.   

I reasoned that this paragraph is precisely on point and affirms my position that compensation for the E&M is proper and, in fact, medically necessary. The paragraph, above, clearly states that “other services must be medically reasonable and necessary for the patient’s medical condition and not related solely to the acupuncture services” (emphasis mine). This rationale immediately clarified the issue. Appropriate treatment decisions can be made only after E&M information-gathering services are performed. The treatment, e.g., acupuncture, selected by a physician is the result of the E&M — not the reverse. The sequence of events in an office visit, especially in the initial visit, makes it impossible for the E&M to relate solely to the acupuncture. The E&M is the first step and one that medically, legally and morally must take place before any treatment can be considered and, therefore, is independent and not related to any other service subsequently performed.    

In addition, the Medicare Report uses the phrase, “In such case.” These words indicate that there are “such cases” where payment is appropriate and proper. If there were to be a denial of payment without exception, the sentence would have read: “In no such case.” As the latter wording was not used, the sentence used indicates that there are such cases where payment is appropriate.     

There are, of course, situations in which the E&M service would not be covered. For example, a subsequent visit following the performance of only E&M and acupuncture services during the previous visit. In this situation, the E&M of the subsequent visit may relate solely to the non-covered acupuncture treatment of the previous visit and would, therefore, not be a covered service. In this case, it is arguable that the E&M follow-up for the subsequent visit was solely for the purpose of determining whether to continue with acupuncture treatment and, therefore, not reimbursable. Careful progress note documentation regarding the totality of the patient’s progress will avoid an adverse conclusion.    

The bottom line? Yes, you can bill Medicare for some E&M. But be careful to document it properly in your progress notes.   

Marshall H. Sager, DO, DABMA, FAAMA
AAMA Board of Directors   

Annual Symposium Preview – Anaheim, CA 

The 28th Annual AAMA Symposium will be held April 7-10, 2016 at the Anaheim Hilton in Anaheim, California. Narda Robinson, MD, DVM, FAAMA, will be chair, assisted by Laura Bowman, MD, DABMA and several committee members working to shape an exceptional program.   As the AAMA Education Committee puts the final touches on the program details, make sure the Annual Symposium dates are on your calendar:  April 5-6 – Review Course April 7 – Pre-symposium Workshops April 8-10 – Annual Symposium  As details are nailed shared, you’ll find them here: http://www.medicalacupuncture.org/ForPhysicians/Symposium.aspx   

New Scientific Research

Attitudes Toward Acupuncture Among Pain Fellowship Directors (Pain Medicine, American Academy of Pain Medicine) 
Results from this survey indicate that acupuncture is widely available to patients at academic medical centers, integrated into many pain fellowship curricula, and considered a useful modality by physician leaders in the field of pain medicine. This sentiment, paired with the flexibility of national guidelines for pain fellowship curricula, suggests a trend toward greater inclusion of this modality in academic medicine.   

Effects of acupuncture at HT7 on glucose metabolism in a rat model of Alzheimer's disease (Acupuncture in Medicine)
Needling at HT7 can improve memory ability and cerebral glucose metabolic activity of the hippocampus, thalamus, hypothalamus, and frontal/temporal lobes in an AD rat model.

Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report (Journal of Alternative and Complementary Medicine)
Conclusion: A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted. 

Call for Entries! Acupuncture Research Paper Competition

Entries for the annual Acupuncture Research Paper competition is now accepting entries. The cut-off to apply to present a Research Paper at the AAMA Symposium 2016 at the Anaheim Hilton in Anaheim, CA, is January 29, 2016. Submissions must be original work, in either clinical research or basic biochemical or physiological research pertaining to acupuncture. The work must not have been previously published. Work completed and accepted for publication during the 2015-16 year period will be considered, if the publishing journal will allow presentation at AAMA Symposium. First, Second and Third Place awards will be presented at the AAMA Symposium in Anaheim. The First Place paper is to be presented in a 30-minute Plenary Session at the Symposium. Papers for Second and Third place are to be announced at the Symposium. Authors will be acknowledged there.   

Chapter & Member News 

Innovative Primary Care is an internal medicine practice blended with CAM practitioners and is looking for an acupuncturist in its Gilbert, AZ, location during the week and/or weekends. Knowledge of naturopathy, homeopathy, etc. would be an added benefit. If you are interested, please visit innovativeprimarycareaz.com or call (480) 776-0626 or email innovativeprimarycareaz@gmail.com.

The seminar, “An Acupuncture Tensegrity Approach to Myofascial Trigger Points,” by Drs. Joe Audette and Allison Bailey scheduled for November 7-8 at Alliance Integrative Medicine had to be cancelled due to a fire in the facility a few days prior. The seminar will be rescheduled for 2016. If you had planned to attend, you will automatically be contacted. If you are interested in attending, but were not on the contact list, please contact Dr. Steve Amoils, President, Ohio Chapter AAMA: Steve.Amoils@myhealingpartner.com.   

Dr. David Miller, Pacific College, Chicago, will present “Exploring Informed Consent in Vaccination:  An Independent Physician's Evidence-Based Perspective for Parents and Professionals” at Pacific College of Oriental Medicine in Chicago, January 10, 2016. Dr. Miller will spotlight these vaccines: pneumococcus, varicella, smallpox, Gardasil/HPV, Hepatitis B, polio, HIB, rotavirus, MMR, pertussis and meningococcal. He will address the conflict of interest when it comes to vaccines, adjuvants, how vaccine schedules have changed and the rise in chronic disease. Registration info: http://ilaaom.org/events-2/

Reminder! Earn Free CME for Reading Journal Articles Journal-based CME credit for AAMA members is now available through the store system on the AAMA website. Just add the course to your cart and "purchase" it for free. You will not be charged. Visit http://www.medicalacupuncture.org/cme/AvailableCMECourses/tabid/3614/c/journal-articles-members/Default.aspx and log in as a member. You’ll receive a coupon for the free CME. 

The Medical Acupuncture Review Course will be help April 5-6, 2016 in Anaheim, CA prior to the Annual Symposium. The Review Course was developed to provide a broad-based refresher course on the major subject matter areas with which a well trained physician should be familiar. The Review Course is especially useful as a refresher for those who obtained their acupuncture training some time ago and for those who are seeking an organized review prior to taking the ABMA Board Certification Examination. Find brochure to download and sign up today! 

Journal CME

Medical Acupuncture, the Official Journal of the AAMA, now contains selected articles that are approved for 1 AMA PRA Category 1 Credit™Mary Ann Liebert, Inc publishers anticipates that 6 articles per year will carry CME credit. 

CME credit is available for free to AAMA members and available to other subscribers and readers for a small fee. 

Click here to access current and past issues of Medical Acupuncture.

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