BLOGS

Dry Needling

Published January 3, 2019

By Wyn Staheli, Director of Research

The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In September of 2018, they made a presentation to the American Medical Association (AMA) CPT Panel which subsequently approved new non-time-based codes which will be in the Surgery section of the CPT code book in the “Procedures on the Musculoskeletal System” section. These new codes describe needle insertion(s) without injection(s) and will likely be effective in January 1, 2020.

So that leaves us with another year to muddle through. Basically, it really boils down to what payers want. The problem is that even though various professional organizations have stated their policies, payer policies are varied. Let’s review these differences.

AMA: The AMA’s position is to use code 20999 which is found in the CPT Assistant, October 2014 (emphasis added):

Dry needling (DN) is a technique in which a thin filiform needle is used to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues. To clarify proper reporting of trigger point services performed using a "dry needle" technique, an article was published in the September 2003 issue of CPT Assistant, stating that codes from the (20550-20553) code range are not intended for reporting a "dry needle" technique, and that dry needling techniques may be reported with the unlisted procedure code 20999, Unlisted procedure, musculoskeletal system, general.

APTA: According to a 2014 statement by the APTA, “If no such specific code exists, then report the service using the appropriate unlisted physical medicine/rehabilitation service or procedure code 97799.”

BC/BS of Lousinana: To further complicate things, a recent (June 2018) Blue Cross/Blue Shield Professional Provider Office Manual Addendum provides new guidance on coding dry needling (emphasis added):

Manual and Massage Therapy Performed as part of Chiropractic Care

Therapeutic procedures (i.e. 97124 & 97140) used to relax or prepare the patient for manipulation are considered fundamental to the manipulation and are included in the manipulation reimbursement when they are performed in the same area on the same day. Dry needling may be reimbursed separately even if performed in the same area on the same day and should be billed as code 97140 with Modifier 59.

Dry Needling (Intramuscular Manual Therapy)

Currently there is no specific CPT code for dry needling, so this service should be billed with CPT code 97140. Unlisted CPT codes should not be used to bill for this service. If dry needling is performed on the same day as chiropractic manipulative treatment (CMT), Modifier 59 should be appended to 97140 so that it may be allowed for separate payment.

Recommendation

If the payer does NOT have a specific policy with a preferred code, it could be argued that either 20999 or 97799 could appropriately be billed. Since the new codes will be in the surgery section, perhaps code 20999 would be the more appropriate choice to use until the new codes are available in 2020.

Who May Perform DN?

Like coding policies, there are scope of practice differences between states and organizations. Perhaps as new codes are assigned, national policies can help to clarify the issue. Previously, acupuncturists have opposed the use of dry needling by PTs, stating that this amounts to practicing acupuncture without a license. However, the new codes clearly state that the intent of dry needling is different than a typical acupuncture service. Some states consider dry needling within the scope of practice for PTs, while other states simply do not prohibit it. Contact your state professional association to determine the rules for your state.

References

UPCOMING RECENT ARCHIVE

Upcoming

Recent

Archive

Calculate fees for your area. Please enter your zip code.

About This Tool

The Basic Medicare Fee Calculator is a helpful tool which uses Resource Based Relative Value Units (RBRVS) to estimate fees. It is only for educational purposes and should not be used as your only source for fee schedule determinations. The percentages included here should only be used as a reference and should be adjusted to fit your individual needs. Please note that some states, such as Florida, mandate specific percentages of the Medicare Fee as the allowed amount for personal injury or other claims.

Instructions

Enter your zip code and click on the [Create Fee Worksheet] button. Geographic adjustments will be applied to the displayed Medicare Fee. The Medicare Fee displayed is the Allowed Amount. To find the Medicare limiting charge for non-participating providers, consult your Medicare Administrative Contractor.

Disclaimer

By providing this tool, ChiroCode does not guarantee or assure correct use and application of fees and or codes to users or any other party. Reasonable effort has been made to verify the accuracy of this tool. The regional Medicare fees used as a foundation for this tool are believed to be accurate and current. Absolute accuracy though of this tool or the use of this tool cannot be guaranteed. ChiroCode will be held harmless of any and all liability arising from fee schedule establishment or management based upon the use of this tool. This tool is not endorsed by the American Medical Association (AMA).

Subscribe to the ChiroCode Newsletter

Stay up to date on the latest Chiropractic Documentation, Coding, Reimbursement and Compliance.



Find-A-Code

Find-A-Code is dedicated to providing the most complete medical coding and billing resource library available anywhere. Find-A-Code's online libraries include extensive information for all major code sets along with a wealth of supplemental information.

Pragma Intel

Caring for personal injury patients? Increase your PI reimbursements. Learn the secrets of working with insurance companies with Pragma Intel Colossus Level 1 Training.



Want to Sell ChiroCode Products?

Contact Us at 602-944-9877 or visit innovihealthsystems.com/dealers/ to become a ChiroCode dealer or affiliate.

Thank you for visiting ChiroCode.com!

For over 25 years, ChiroCode has led the way in helping the chiropractic profession with coding and reimbursement issues. Our mission is to help chiropractors and their staff get the information they need to run a successful and compliant practice.

Our flagship product, the annual ChiroCode DeskBook, contains the essential codes and other information you need to assist with proper coding and compliance. ChiroCode's products focus on the following areas:

Documentation

Patient documentation is the foundation of every patient visit in chiropractic practices. It establishes and supports the need for patient care. It is also one of the most highly cited problems by the OIG. Providers must have thorough documentation that adequately meets medical necessity requirements in order to receive and keep third-party reimbursement. Documentation requirements can seem daunting. However, with the help of ChiroCode, documenting correctly for new and established patient visits, consultations, daily visits, therapies, and products supplies can become more clearly understood and more efficient.

Coding

Coding includes the CPT, HCPCS, and ICD-10-CM code sets that chiropractic and other medical providers are required to use to communicate patient procedures, symptoms, and conditions. Coding tends to be an area of uncertainty in chiropractic which can lead to erroneous code selection which can in turn lead to provider vulnerability. ChiroCode is an industry leader in coding compliance and provides valuable resources to build practice confidence in coding.

Reimbursement

Reimbursement for services rendered should be a consistent, organized, efficient, and predictable cycle in every practice. The health of a practice depends on it. Reimbursement may include: patient collections, insurance billing, patient billing, accounts receivable management, management of claims follow-up, appeals and resubmissions. ChiroCode understands the complexity of all parts of the reimbursement cycle as well as the need for proper systems and the ability for a provider/owner to monitor this department and reduce provider risk.

Compliance

Medical practices are under increased scrutiny for healthcare fraud and abuse. Provider compliance programs are mandated by the Patient Protection and Affordable Care Act of 2010. Sound compliance plans must be implemented and carefully followed in order to protect your organization. Chirocode helps providers minimize risk by addressing the various levels of compliance, including HIPAA, OIG (Office of Inspector General), and OSHA.

PRODUCTS