CPT 97813 is an acupuncture procedure code involving electrical stimulation for an initial 15 minutes of personal one-on-one contact with the patient. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97813 procedures.
1. What is CPT 97813?
CPT 97813 is a medical billing code used for acupuncture procedures that involve the use of electrical stimulation during the initial 15 minutes of personal one-on-one contact with the patient. This code is specifically used for electroacupuncture, a therapeutic intervention that provides relief or prevention of pain, treatment of post-operative and chemotherapy nausea and vomiting, stroke rehabilitation, and treatment of asthma, addiction, and various other health conditions.
2. 97813 CPT code description
The official description of CPT code 97813 is: “Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.”
The 97813 procedure involves the following steps:
- The provider locates the appropriate acupuncture points on the patient’s body by pressing on the skin and feeling them with their fingers.
- The provider marks the location by pushing down on the skin and cleaning the site.
- The provider selects the appropriate needle lengths and gauges and carefully inserts the needles into the marked points.
- The provider mildly stimulates the needles by various techniques such as rotating the needle or inserting and withdrawing the needle repeatedly.
- Electrodes are attached to the shafts of the needles, and an appropriate electrical current is selected.
- The provider slowly increases the frequency and intensity of the current until the patient reaches their tolerance level.
- The patient is instructed to rest for a period of time with the needles still inserted.
- The provider returns periodically to check on the patient and manipulate and/or adjust the electrical stimulation on the needles as necessary.
- When the desired effect is achieved, the provider removes the electrodes, disposes of the needles, and presses on the points with a cotton ball to prevent bruising or bleeding.
- The provider provides the patient with post-procedure instructions and charts the procedure.
4. Qualifying circumstances
Patients who are eligible to receive CPT code 97813 services are those who require acupuncture treatment with electrical stimulation for the relief or prevention of pain, treatment of post-operative and chemotherapy nausea and vomiting, stroke rehabilitation, and treatment of asthma, addiction, and various other health conditions. The provider must determine that electroacupuncture is the most appropriate treatment for the patient’s condition and that the patient can tolerate the electrical stimulation involved in the procedure.
5. When to use CPT code 97813
It is appropriate to bill the 97813 CPT code when the provider performs an initial 15-minute electroacupuncture treatment involving personal one-on-one contact with the patient. The code should not be used for subsequent 15-minute increments of treatment or for acupuncture procedures that do not involve electrical stimulation.
6. Documentation requirements
To support a claim for CPT 97813, the following information should be documented:
- Patient’s medical history and presenting symptoms
- Provider’s assessment and diagnosis
- Rationale for using electroacupuncture as the chosen treatment method
- Details of the procedure, including the acupuncture points used, needle lengths and gauges, and electrical stimulation settings
- Duration of the initial 15-minute treatment
- Provider’s observations and patient’s response to the treatment
- Post-procedure instructions given to the patient
7. Billing guidelines
When billing for CPT code 97813, keep in mind the following guidelines:
- Only one initial acupuncture code can be reported per patient per date of service.
- Acupuncture is billed based on 15-minute increments of personal, face-to-face time with the patient, not the time the needles are in place.
- Do not report non-electrical stimulation codes (97810 or +97811) in addition to electrical stimulation codes (97813 and +97814) for the same 15-minute increment.
- Subsequent 15-minute incremental treatments can be reported using +97811 or +97814, depending on whether manual or electrical stimulation is used during that additional time.
- If the patient’s condition requires service above and beyond the usual scope of service associated with the acupuncture treatment, an E/M service can be reported separately by appending modifier 25. The E/M time is not included in the time of the acupuncture service.
8. Historical information
CPT 97813 was added to the Current Procedural Terminology system on January 1, 2005. The code was changed on January 1, 2006, with the previous descriptor being “Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes of personal one-on-one contact with the patient.”
9. Similar codes to CPT 97813
Five similar codes to CPT 97813 and how they differentiate are:
- CPT 97810: Acupuncture without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
- +97811: Acupuncture without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient.
- +97814: Acupuncture with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient.
- CPT 97899: Unlisted acupuncture service or procedure.
- CPT 97140: Manual therapy techniques, such as mobilization or manipulation, without the use of needles or electrical stimulation.
Here are 10 detailed examples of CPT code 97813 procedures:
- A patient with chronic lower back pain receives electroacupuncture to alleviate pain and improve mobility.
- A patient undergoing chemotherapy receives electroacupuncture to reduce nausea and vomiting associated with their treatment.
- A stroke survivor receives electroacupuncture as part of their rehabilitation program to improve muscle strength and coordination.
- A patient with asthma receives electroacupuncture to help manage their symptoms and reduce the frequency of asthma attacks.
- A patient with an addiction to opioids receives electroacupuncture as part of a comprehensive treatment plan to manage withdrawal symptoms and reduce cravings.
- A patient with migraines receives electroacupuncture to help prevent the frequency and severity of their headaches.
- A patient with fibromyalgia receives electroacupuncture to help manage their chronic pain and improve their overall quality of life.
- A patient with carpal tunnel syndrome receives electroacupuncture to alleviate pain and improve hand function.
- A patient with irritable bowel syndrome receives electroacupuncture to help manage their symptoms and improve their overall gastrointestinal health.
- A patient with anxiety and depression receives electroacupuncture as part of a comprehensive treatment plan to improve their mental health and well-being.