ACUPUNCTURE FOR WOMEN'S HEALTH & FERTILITY

Information Relevant to Insurance /
Flex Spending Submissions
 

" As you already know, I don’t bill or work directly with insurance. When insurance runs the show they delegate how many treatments I can provide YOU, what I can and cannot bill for, the structure of my visits, the pace I need to work, etc. None of that fits my model of care or what I feel most of my patients appreciate and really need. "
 

Please use this handy guide as a resource if you are trying to submit to your insurance for reimbursement. Please know since I don't bill through insurance, I’m not an expert, so I won't be able to answer your questions. And I have to mention I won't be calling, submitting or directly billing them for you. We're happy to help where we can, and so we created this guide. If you need further assistance such as a report with all your visit dates, please use the button below to email my office manager, Mark.
 

 

 

Procedure Codes

CODE #1
Chatting / Check-In / Education Time 

Select only 1 from the following visit options. 

 

REGULAR VISIT
Use this code for a normal 75 minute visit.
 

99214 Evaluation / Management - Detailed
Detailed history, detailed examination, moderate complexity.
Provider spends 25 minutes face to face with patient.
 

- or -
 

EXTENDED or DELUXE VISIT
Use 1 of the following codes for any visit that was longer than a normal 75 minute visit.
 

99202 Evaluation / Management - Expanded
Expanded history, examination and medical decision making.
Provider typically spends 20 minutes face to face with the patient.

99203 Evaluation / Management - Detailed
Detailed history, examination and medical decision making.
Provider typically spends 30 minutes face to face with the patient.

99204 Evaluation / Management - Comprehensive
Comprehensive history, comprehensive examination, moderate complexity.
Provider typically spends 45* minutes face to face with the patient. 

* Any amount of time >45 minutes will not be covered, so simply choose 99204 and get the most time possible. 
 

 

CODES #2 thru 6
Actual Treatment Time

 

ACUPUNCTURE
Pick 1 from each of the following 2 groupings.
 

97810 Initial 15 Minutes of Insertion of Needles

97813 Initial 15 Minutes of Insertion of Needles with Electrical Stimulation 
 

- and -
 

97811 Subsequent Unit of Acupuncture
(One unit = additional 15 minutes)

97814 Subsequent Unit of Acupuncture with Electrical Stimulation
(One unit = additional 15 minutes)
 

 - FINALLY -
 

INCLUDE ANY ADDITIONAL SERVICES
Select any if applicable to your visit.
 

97016 Cupping

97026 Heat Lamps
Superficial infrared heat in conjunction with other procedures

97124 Massage (Tui Na Massage)
15 minutes of one on one direct patient contact

 

 

Cost Assigning

Example of a Typical 75-Minute Visit

Your Total Visit Fee should always equal my normal visit rate. If more additional services were provided at your visit, adjust the individual amounts so they still total the visit rate when added. They are all a part of my service!
 

Date of Service - 01/01/2021
Total Visit Fee - $110

99214 - $50
Evaluation / Management - Detailed

97810 - $20
Initial 15 Minutes of Acupuncture

97811 - $20
Subsequent Acupuncture Unit

97124 - $10
Tui Na Massage

97026 - $10
Heat Lamps
 

 

 

ICD-10 CODES

If your insurance required ICD-10 Codes for Diagnosis, you will find many of the common ones below. If you need a more complete (and complex) listing, here's a link for you.

 

MENSTRUATION

Anovulatory  N97.0

Cycle, Irregular  N92.6

Delayed  N91.0

Disorder  N93.9
- psychogenic  F45.8

During Pregnancy  O20.8

Excessive (with Regular Cycle)  N92.0
- with irregular cycle  N92.1
- at puberty  N92.2

Frequent  N92.0

Infrequent — see Oligomenorrhea

Irregular  N92.6
- specified NEC  N92.5

Latent  N92.5

Membranous  N92.5

Painful  N94.6
- primary  N94.4
- psychogenic  F45.8
- secondary  N94.5

Passage of Clots  N92.0

Precocious  E30.1

Protracted  N92.5

Retained  N94.89

Retrograde  N92.5

ScantyN94.89

 

MIGRAINE (IDIOPATHIC)
G43.909
 

MENSTRUAL MIGRAINE
G43.829
 

ANXIETY DISORDER
F41.9
 

SITUATIONAL DEPRESSION
F34.1
 

MILD DEPRESSION
F34.1
 

DYSTHYMIC DISORDER
F34.1
 

ADJUSTMENT DISORDE
Grief, emotional crisis, emotional upset  F43.20
 

GENERAL DIGESTIVE SYMPTOMS

Dyspepsia (Indigestion)  536.8
Nausea  R11.0
Heartburn  R12
Constipation  K59.0

PAIN

Abdominal  R10.9
- generalized  R10.84
- - pelvic or perineal  R10.2
- - periumbilical  R10.33
- - right quadrant  R10.31

Back (Postural)  M54.9

Bladder  R39.89

Breast  N64.4

Broad Ligament  R10.2

Chest (Central)  R07.9

Chronic  G89.29

Coccyx  M53.3

Colon — see Pain, Abdominal

Costochondral  R07.1

Diaphragm  R07.1
- genital NEC  T83.84

Ear  H92.0

Epigastric, Epigastrium  R10.13

Eye — see Pain, Ocular

Face, Facial  R51
- atypical  G50.1

Female Genital Organs NEC  N94.89

Finger — see Pain, Limb, Upper

Flank — see Pain, Abdominal

Foot — see Pain, Limb, Lower

Gallbladder  K82.9

Gas (Intestinal)  R14.1

Gastric — see Pain, Abdominal

Generalized NOS  R52

Genital Organ
- female  N94.89
- male  N50.8

Hand — see Pain, Limb, Upper

Head — see Headache

Heart — see Pain, Precordial

Infra-Orbital — see Neuralgia, Trigeminal

Intercostal  R07.82

Intermenstrual  N94.0

Jaw  R68.84

Joint  M25.50
- ankle  M25.57
- elbow  M25.52
- finger  M79.64
- foot  M25.57
- hand  M79.64
- hip  M25.55
- knee  M25.56
- shoulder  M25.51
- toe  M25.57
- wrist  M25.53

PAIN (continued)

Leg — see Pain, Limb, Lower

Limb  M79.609
- lower  M79.60
- - foot  M79.67

Low Back  M54.5

Lumbar Region  M54.5

Menstrual  N94.6

Musculoskeletal  M79.1

Myofascial  M79.1

Nasal  J34.89

Nasopharynx  J39.2

Neck NEC  M54.2

Nerve NEC — see Neuralgia

Neuromuscular — see Neuralgia

Nose  J34.89

Ocular  H57.1

Orbital Region — see Pain, Ocular

Ovary  N94.89

Ovulation  N94.0

Pelvic (Female)  R10.2

Penis  N48.89

Premenstrual  N94.3

Stomach — see Pain, Abdominal

Tooth  K08.8

Trigeminal — see Neuralgia

Ureter  N23

Urinary (Organ / System)  N23

Uterus NEC  N94.89

Vagina  R10.2