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August 2002
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AAMA President welcomes board members, outlines affiliation with AARP
By Marshall H. Sager, DO, DABMA
PRESIDENT, AAMA
We have had so many positive comments about AAMA's 14th Annual Symposium in Los Angeles that our newly expanded Symposium Committee--under the outstanding leadership of Roberto Jodorkovsky, MD, DABMA--is energized and busily planning next year's meeting in Baltimore. He and his committee promise a dynamic program filled with interesting and enlightening speakers and some surprises. Stay tuned!
I am so pleased to welcome Kathleen Moore Bishop, MD, DABMA, as a new Board member and am delighted that William Clearfield, DO, DABMA, will, once again, add his unique perspective to the Board. I know that Kathy and Bill will add a fine dimension to our meetings and will be driving forces in attaining our goals of excellence in medical acupuncture education and practice.
Many of us who attended the Practice Management lecture at our recent Symposium were concerned that some of the information disseminated was either non-specific or incorrect. To that end, Mark Painter of Relative Value Studies, Inc. has submitted a written correction to the information supplied. PLEASE take special notice of this amended information that appears on this page. It is vital for each of us to correctly understand proper coding procedures. To that end, I urge each of you to READ his article and RETAIN it for future reference.
Next, I want to extend my warmest congratulations to John Reed, MD, one of the Academy's Founding Fathers. He is vice president, Medical Affairs of American WholeHealth. You will find information about American WholeHealth and a special AAMA member discount on page 3 in this newsletter.
And finally, kudos and congratulations to immediate past president Bryan Frank, MD, DABMA. At a recent meeting in Edinburgh, he was elected vice president of the International Council of Medical Acupuncture and Related Techniques (ICMART). Bravo, Bryan! (See report posted at: medicalacupuncture.org.)
In keeping with my desire to encourage each of you to participate in YOUR Academy, I have been using this column to explain our standing Committees:
- MEDICAL ACUPUNCTURE REVIEW/JOURNAL
- 2003 SYMPOSIUM COMMITTEE
- BUDGET COMMITTEE
- MEMBERSHIP COMMITTEE
- EDUCATION COMMITTEE
- CME COMMITTEE
- MEDICAL ACUPUNCTURE REVIEW COURSE
- MEDICAL ACUPUNCTURE ADVISORY COMMITTEE*
- WEBSITE COMMITTEE
- VOLUNTEER RECRUITMENT COMMITTEE
*I continue with the Medical Acupuncture Advisory Committee. I have a personal interest in MAAC as I had the privilege of creating this Committee and chairing it for many years. With 5-11 members, MAAC has a broad and exciting jurisdiction. Its purpose is to oversee state legislative initiatives and confront challenges, serve as the liaison to state chapters and generally act to inform, educate and advise about the advantages and benefits of medical acupuncture.
The MAAC's goals include: establishing a state and national communications tree to address legislative issues; assessing the value of the video script and training Chapters in video scripting, and identifying state and federal acupuncture legislation potentially harmful to medical acupuncture and developing strategies to address it.
I found my MAAC work extremely satisfying. I enjoyed interacting with fellow AAMA members and working on projects that influence vital aspects of our practice. If you decide to participate in this committee under the leadership of William Rutenberg, MD, DABMA, you will enjoy being on the cutting edge of the Academy's work.
To join MAAC, contact Dr. Rutenberg (wdrutenber@aol.com, 847/634-4782).
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Relative Value Studies, Inc. issues clarification on codes presentation
By Mark N. Painter, CEO
RELATIVE VALUE STUDIES, INC., DENVER, CO
On April 19, as part of AAMA's 14th Annual Symposium in Los Angeles, a representative of Relative Value Studies, Inc. gave a Practice Management presentation that included information about evaluation and management coding, relative values and general reimbursement.
We most sincerely regret that some of the information provided was incorrect.
Specifically, codes 97780 and 97781 (acupuncture and acupuncture with electrical stimulation) were referred to as global procedure codes. In fact, these codes are considered to be medical services and do not, currently carry a global procedure designation.
I would like to formally clear up the controversy and confusion surrounding the use of evaluation and management codes (E/M) with the acupuncture codes 97780 and 97781 during the same patient encounter. From a straight coding perspective, if the rules of the primary relative value systems of the Resource Based Relative Value System (RBRVS) or Relative Values for Physicians (RVP) are followed, evaluation and management services should be allowed separately in addition to the acupuncture services. Evaluation and management codes for new patients, consultations, or established patients should not be considered bundled into the acupuncture service.
Additionally, the presenter should have emphasized the need for thorough documentation of significant, separate and identifiable evaluation and management services prior to submission of both the evaluation and management code and the acupuncture service code. To emphasize, the values assigned in both the RBRVS and the relative value system published by Ingenix, Relative Value for Physicians, are set so that that the evaluation and management of a patient is a separately billable service.
Furthermore, the use of a modifier should not be required with the E/M code. Administration of these service codes and the rules applied by various payers is disparate and not well coordinated. Therefore, there may be some payers who require the use of modifier -25 and documentation supporting that a significant and separately identifiable E/M service was provided during the acupuncture encounter. The speaker should have indicated that, it is prudent to append the modifier -25 to E/M services billed in conjunction with acupuncture, if the payer stance relative to payment of both services is unknown or the payer is known to require the modifier.
One further issue omitted from the presentation is that many payers hold that E/M services or specified levels of E/M services are not medically necessary with every acupuncture visit. For those payers who deny payment for E/M services in addition to acupuncture or for those payers who request further documentation for particular levels of service regardless of the reporting codes used, the physician must take the time to determine the reason for the denial. Successful appeals of these denials are infrequent and rarely result in a change of payer policy. We suggest dialoguing with the payer's medical director or renegotiating the physician contract to resolve this issue.
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Academy to benefit from AARP affiliation
AAMA has agreed to be a Platinum Partner with American WholeHealth and in doing so, will reap the benefits of its affiliation with AARP and exposure to millions of AARP members who can benefit from medical acupuncture.
AAMA member John C. Reed, MD, is vice president, medical affairs of American WholeHealth, which forms and administers networks of CAM practitioners. The company's mission is to help practitioners and clients prosper in the healthcare marketplace by making those who offer complementary and alternative medicine services available to members of American WholeHeath's clients. They contract with health plans to identify, credential and manage CAM practitioners as part of a plan's covered benefits program.
In addition, the company contracts with associations, employers and health plans to administer a WholeHealth and Wellness Network to market professionals (such as AAMA physicians) in the health, wellness and lifestyles service fields to members of associations, employer groups and health plans for cash-pay services not now covered nor not intended for coverage by health insurance payments.
The company recently became the exclusive contractor for AARP's Health Care Options national program to provide an Alternative Health and Wellness Network for AARP's 35 million members. AAMA will benefit from exposure to millions of AARP members with disposable income who can greatly benefit from medical acupuncture.
By being part of American WholeHealth, the Academy will be included in publicity about the AARP Health and Wellness Network Sept. 10-14 in San Diego during AARP's large annual "Life Over 50" member event.
AAMA members are being offered a 20% discount off American WholeHealth's annual individual Platinum Participating Practitioner member rate. In addition to being marketed to AARP, Academy members who join American WholeHealth will receive help in practice building and management. Academy practice members and ABMA designees meet the company's educational and training credentialing standards for CAM network participation.
For more details on benefits or to join the American WholeHealth program, contact Dr. Reed (reedj@awhinc.com, 703/444-5731) or log on to: awhinc.com.
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