Mastering the 97810 Billing Guidelines: Essential Information for Chiropractors

As chiropractic care continues to evolve, one area that remains crucial for practice success is billing and coding. Correctly understanding and applying the right codes not only ensures that your practice gets paid fairly but also helps avoid denials, audits, and unnecessary delays. Among the various codes used in chiropractic care, the 97810 CPT code is essential when dealing with acupuncture services. This article breaks down the 97810 billing guidelines, helping chiropractors streamline their billing process and maintain compliance with industry standards.

What is the 97810 CPT Code?

The 97810 CPT code refers to acupuncture services provided by a licensed healthcare provider. This code is specifically used for acupuncture treatment for conditions like musculoskeletal pain, arthritis, or other conditions that acupuncture can help manage.

The 97810 billing guidelines focus on ensuring that the acupuncture service is documented thoroughly and that the code is applied correctly based on the complexity of the treatment. This code is primarily used for one session of acupuncture and is billed per 15-minute increment.

Importance of Accurate Billing for Acupuncture Services

Accurate billing is essential for chiropractors to get reimbursed promptly and avoid potential issues with insurance companies. Acupuncture is an increasingly popular treatment in chiropractic practices, making it even more important to understand the correct way to bill for these services.

The 97810 billing guidelines ensure that chiropractors are compensated fairly for their time, expertise, and the resources required to treat the patient. Failing to properly apply these guidelines can lead to denied claims and a delay in payment, hurting the practice’s financial health.

Detailed Documentation for 97810 Billing

For chiropractors to correctly bill using the 97810 CPT code, certain documentation requirements must be met. The key here is providing thorough, detailed, and accurate records that justify the use of this code.

Here are the core elements of documentation for acupuncture treatment:

Patient’s Medical History and Diagnosis:
Ensure the patient’s medical history is documented clearly, especially the condition being treated. For acupuncture, conditions like chronic pain, arthritis, and migraines are commonly treated, so these diagnoses must be included in the patient’s medical record.

Acupuncture Treatment Plan:
Describe the acupuncture treatment plan, including the number of acupuncture needles used, the location of the needles, and the method of insertion. Additionally, note the patient’s response to previous treatments and any changes in the treatment approach.

Time Spent on Treatment:
Accurate time tracking is essential for billing. The 97810 CPT code is based on 15-minute increments, so be sure to note how much time was spent on the acupuncture session, especially since time-based codes often require precise documentation to avoid audits.

Billing for Acupuncture Services: A Step-by-Step Guide

Understanding how to bill using 97810 is crucial for chiropractors looking to include acupuncture in their practice. Here’s a step-by-step guide on how to handle 97810 billing correctly:

Step 1: Verify Patient Eligibility
Before administering acupuncture, verify that the patient’s insurance covers acupuncture services. Some insurance providers may have limitations or specific guidelines for acupuncture billing, so this step ensures that the treatment will be covered.

Step 2: Record the Treatment Details
Document all relevant treatment information, including the exact acupuncture points treated, the duration of the session, and any other relevant details. This helps justify the application of the 97810 CPT code.

Step 3: Bill Using the Correct CPT Code
Use the 97810 CPT code for the initial 15 minutes of acupuncture treatment. If the treatment lasts longer, you can bill additional 15-minute increments using the same code. It’s essential to follow the exact time increments to avoid over-billing or under-billing.

Step 4: Submit the Claim
Once you’ve completed the documentation and verified the treatment details, submit the claim to the insurance provider. If using a billing service or software, double-check that the 97810 CPT code is correctly entered, along with any other supporting information such as patient diagnosis and treatment time.

Common Challenges and Errors with 97810 Billing

Billing for acupuncture services can be tricky, especially with the 97810 billing guidelines. Here are some common errors and challenges that chiropractors may face:

Incorrect Documentation:
One of the most common issues chiropractors face when billing for acupuncture services is inadequate or incomplete documentation. Ensure that all aspects of the treatment are clearly outlined, including the patient’s condition, acupuncture points, and treatment plan.

Misunderstanding Time Increments:
Acupuncture billing under the 97810 CPT code is time-based. Many practices struggle with accurate time tracking, which can lead to over-billing or under-billing. Make sure to round the time to the nearest 15-minute increment and document it properly.

Ineligible Insurance Coverage:
Not all insurance companies cover acupuncture services, and some may have specific requirements for these types of treatments. Be sure to verify coverage before providing acupuncture to avoid costly billing issues.

Lack of Insurance Understanding:
Insurance providers may have different guidelines for acupuncture billing, such as the number of sessions allowed or restrictions on certain conditions. Make sure you’re familiar with each payer’s specific rules for acupuncture services.

Leveraging Health-Tech Solutions to Streamline Acupuncture Billing

Technology can play a significant role in simplifying acupuncture billing for chiropractors. With the right billing software, practices can eliminate manual errors, streamline the documentation process, and ensure proper coding and compliance.

Here’s how technology can help streamline the 97810 billing guidelines:

Automated Time Tracking:
Many billing software systems automatically track treatment time, making it easier to document acupuncture sessions accurately. This ensures that chiropractors can bill based on exact 15-minute increments, reducing errors.

EHR Integration:
An integrated Electronic Health Record (EHR) system ensures that patient diagnoses, treatment plans, and session notes are easily accessible and automatically linked to billing codes like 97810. This reduces the risk of missing information and ensures more accurate claims.

Claim Scrubbing:
Advanced billing software includes “scrubbing” features that automatically check claims for potential errors before submission. This can help detect missing documentation or incorrect code usage, preventing denials and delays.

Real-Time Payer Updates:
Health-tech platforms often offer real-time updates about payer policies and coding changes. This helps ensure that chiropractors are always up-to-date with the latest rules and can avoid issues when submitting claims.

Tips for Chiropractors to Improve Acupuncture Billing Efficiency

Improving your acupuncture billing processes not only ensures compliance but also enhances revenue cycle management. Here are some useful tips for chiropractors to enhance their acupuncture billing practices:

Use Billing Software Designed for Chiropractic Practices:
Invest in specialized billing software designed for chiropractic practices. This software is tailored to accommodate both traditional chiropractic services and acupuncture treatments, ensuring proper code usage and billing accuracy.

Educate Your Staff:
Make sure that your front desk and billing staff are trained on the specifics of acupuncture billing, including the 97810 CPT code and the 97810 billing guidelines. This ensures that all claims are processed correctly and reduces the chances of mistakes.

Stay Up to Date with Insurance Requirements:
Insurance policies and requirements can change frequently, so it’s important to stay informed about the latest guidelines for acupuncture billing. Regularly check with insurance companies to verify that you are following their most up-to-date rules.

Review and Audit Your Claims:
Regularly review and audit your claims to ensure that your billing practices are in compliance with industry standards. This helps identify areas for improvement and prevent issues before they arise.

Conclusion

Billing for acupuncture services using 97810 can seem complex, but with the right understanding of the 97810 billing guidelines, chiropractors can ensure they are reimbursed correctly and avoid the risk of claim denials. Accurate documentation, understanding time-based billing, and leveraging modern billing software can streamline the process and boost the financial health of chiropractic practices.