|
CPT Codes
Holly Leeds:
I am having a small problem with worker's comp in California. I billed CPT 97781 for acupuncture with electricity oon a patient, and they tell me that that is not a code for WC in CA? The options that I was given by the insurance company are 97790, 97800, 97801-803. Does anyone have experience in what code to use? None of those codes are even in my CPT 2000 code book! Thanks for any suggestions-
Kimber Rotchford:
In the state of Washington worker's compensation pays for dry needling of trigger points using the 20550 code...I talk it about as such in my notes and that works for me.
Allen Fein:
The BS here in NY runs like this when I bill for electroacupuncture and the E&M component: The electroacupuncture is downcoded to 99213 My 99213 or 99212 is not paid, as they refuse to pay both an E&M code and acupuncture code same day! I have written letter of protest to Workers Comp and a letter of complaint to New York Insurance Board.
Marshall Sager:
Allen - As a licensed physician in NY, it is legally and ethically mandated that you perform an E/M service each time you see a patient. Treatment is not a part of this service. If you and the patient decide to utilize acupuncture as a result of the management options, then a separate treatment service charge is applicable which may or may not be covered by insurance. I would suggest you contacting your State Medical Society for support re this concept.
Allen Fein:
Thank you for the input. I agree with your points. I am a member of the American Academy of Medical Acupuncture and the American Academy of Family Physicians, but not at present, the AMA. Unfortunately, the Academy of Family Physicians is not really there to help me with this sort of problem. I did send copies of my complaint letters to the New York State Insurance Department and the AAMA however. The State Medical Society falls under the AMA. I am not in a position to pay for all 3 association dues at present time. I have not heard back from our AAMA leadership about this problem, and am uncertain how they are lobbying to resolve this sort of annoyant and arrogant behavior from certain members of the insurance industry.
Marshall Sager, AAMA President Elect:
Allen - May I suggest the following -
1. If the American Academy of Family Physicians is not sensitive to your problem, you might consider spending your dues money in another place - namely, The State Medical Society.
2. Your problem is not unique to Medical Acupuncture. This type of abuse by insurance companies is widespread and usually occurs whenever a concomitant procedural service is submitted along with a E/M code submission. It is impossible, inappropriate, and impractical for the AAMA to "lobby(ing) to resolve this sort of annoyant[sic] and arrogant behavior from certain members of the insurance industry". This is primarily a Physician vs. Insurance Company issue.
3. You have just "heard back from our AAMA leadership"
Goeffrey Kloster:
Why is it inappropriate for a professional organization to lobby on behalf of its members and on behalf of better service to their patients?
Stephen Taylor:
I can't bite my tongue any longer. Here in Texas, the Texas Osteopathic Medical Association has lobbied the Legislature to make a rule that when we treat a patient with OMT that BY LAW we can charge an EM code IN ADDITION to the OMT codes. This never would have happened if it was up to the state medical society, as it was not their ox that was getting gored. In my opinion the AAMA is the organization that has the resources and the knowledge to lobby these people. As long as we are percieved as physicians who do acupuncture, we will be lumped in with the CA's. When we advocate with these people that we are physicians who are providers of comprehensive care of patients (EM) and also use acupuncture as a tool to treat patients we will be able to get paid for both.
Marshall Sager:
The AAMA is constantly "lobbying" on behalf of its members and on behalf of better service to their patients. I and other members of the Board have been on Capitol Hill visiting and talking with politicians at various times. Other Board members have testified before such bodies as the AMA CPTcommittee on behalf of the membership. I have written dozens of letter in my capacity as federal and state liaison in support of physician acupuncture practice rights. We have been successful, through such efforts, in securing acupuncture practice rights for the physicians in Montana and Rhode Island. The Academy retains a professional PR/Lobbying firm to aide and assist us in the these and other areas. Additionally, the Academy has established a growing Chapter network around the country through which such local problems can be addressed. The Academy is ready, willing and able to assist its members whenever possible.
Holly Leeds:
Does anyone remember what my original question was, because the discussion has gone far afield. I finally DID find the codes, the CA Worker's Comp system uses the old codes.
Kimber Rotchford, MARF President:
I concur,
Acupuncture is a surgical procedure and separate from the E and M that is evaluating the patient not only in terms of whether acupuncture is appropriate but whether other interventions are indicated. Patients with Chronic pain also need significant and appropriate counseling/education etc. I'm willing to negotiate being paid a fee similar to a non-physician for performing the procedure of acupuncture but I think the entire house of medicine will support us that it is entirely inappropriate to discount the value of your E/M services. I believe the code of acupuncture should be reimbursed similar to that of Trigger point work. Perhaps acupuncture has less theoretical risks than trigger point work associated with larger needles and injected material. On the other hand, the knowledge, skill, and experience required to properly perform it is greater in my opinion than for trigger point work.
Rebecca Bingham:
I'm afraid I am at a loss as to why it is "inappropriate" and "impractical" for the one organization that "gets' what we are doing, to try to help with this inequitous situation.
Allen Fein:
my thoughts too. I was wordless when I read the reply from our Pres elect.
Allen Fein -(in response to Stephen Taylor):
Thank you for the appropriate feedback. I think many may have missed your message (see Stephen Taylor; above)
Allen Fein:
I hope that our Pres elect gets these messages! Lobbying on our behalf must be part of the AAMA priorities. This is not just a fight between Allen Fein, solo MD at the end of Long Island and some dirt bag company called the State Insurance Fund.
Kimber Rotchford:
Most laws relating to insurance and coverage are regulated on a state by state basis. I know that in our State of Washington the laws are unique and getting insurance companies to respond "appropriately" are best handled through State organizations. Our local chapter of the AAMA I felt responded well to a threat by non physicians to exclude physicians from insurance coverage for acupuncture. But it happened on a State level. The only thing I think to expect from the national organization is support and advice with regard to pursuing "local" options. Basically we are dealing with "politics" and politics on the State level are still the most important.
Geoffrey Kloster:
Sounds like a good argument toward forming state chapters of AAMA. I tried stimulating some interest about a year ago when I completed the UCLA course. I got lots of "Yeah, we should do it." but no "Yeah, I'll help." But I didn't put a lot of energy into it either. The demands of the medical systems today are overwhelming in themselves. Perhaps some of you in states with chapters can tell us how it was done?
Allen Fein:
Your recommendation is excellent. New York does not have a local chapter, which is a bit unusual considering all the Tai Yang types in the neighborhood! If there is anyone out there who wants to start a New York chapter, please let me know. I have been rather busy setting up an office in Family Practice/Medical Acupuncture these past 5 months, so I really don't want to take the lead in such a project! Also, I have less than two years in the field of acupuncture. I know that there are quite experienced acupuncture physicians in New York City, who really ought to take the initiative. Perhaps we could start with a mailing to New York MD acupuncturists.
Marshall Sager:
Appropriately, the AAMA can help with the formation of a Chapter. Through the MAAC organization, I developed a template package for such a project. When successfully completed the Academy will provide a grant of $1000 to the new Chapter.
Allen Fein:
That sure will buy a lot of stamps! Thanks for the advice. I have no idea at all, what sort of time and costs are involved in such an undertaking.
Stephen Taylor:
As someone who has entered the political muck here in Texas to get things done I must admit there is no sustitute for local politican'. When you play with politicians you have to make friends with them. You can't just wait until you need them. You have to help them when they need it, ie. time and money. The CA's in this state bragged to me that they contributed $60,000 to the Governors campaign and got the law passed on Acupuncture rights in Texas. It is not JUST money that runs things, but well placed contributions grease the wheels in an impressive fashion. You can choose to look away, or you can face reality and do your part to advocate the positions you believe in. I think we need to start a PAC.
Rebecca Bingham:
Isn't this what's called bribery in other countries?
Allen Fein:
wow. I guess they took that from Texas Chin Acup membership dues. I am on the county Democratic Committee, out here on Long Island, and practice acupuncture on one of the elected County Legislators. Our sessions are always positive experiences for both of us.... in between his screams, I get to lobby!
Paul J Allen - (to Stephen Taylor):
This sounds like a very worthwhile idea. What is in the works presently towards a PAC? Is there any movement in the AAMA towards this direction? Do we have to wait till the next general membership meeting and have it brought up on the floor as a motion?
|
