Billing & Coding: Avoiding Denials for Exams

Welcome to your billing and coding weekly solutions by American Acupuncture Council Network (AAC).

Are you experiencing denials for patient exams and re-exams?

Remember, exams and re-exams must be documented as separate and distinct from the pre and post evaluation associated with acupuncture.

For an examination the 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, how the patient’s condition is changing, and an evaluation of the area of care is considered integral.

An E&M is appropriate approximately every 30 days for an ongoing care plan unless there is a new injury, complaint or some substantial change.

For a full re-exam, the evaluation required for an E&M should include:
How the patient has changed since the initial date of care
A complete evaluation comparing all the original exam elements
An updated care plan and goals.

Remember, billing with incorrect acupuncture CPT and ICD codes can lead to claim rejections and delays in payments, which can have a devastating impact on generating revenue and keeping you in business. 

If you are experiencing insurance claim denial, staff spending too much time trying to get claims paid, and patients asking why their claims have not been paid then American Acupuncture Council Network is your solution.

American Acupuncture Council Network stays ahead of the curve on the latest trends and changes in billing and coding by utilizing their direct channel of communication with the insurance companies and organizations that set the guidelines.

There is a reason acupuncturists have trusted AAC with their business for over 30 years.