Samuel A. Collins
Q: Recently I have begun to utilize more herbal remedies in my practice. Is there a code to bill for the time I spend with the patient, as well as for the herbs themselves?
A: First and foremost, be sure the state in which you practice has specific language within the acupuncture scope of practice for the use and ability to prescribe herbal remedies. Not all states allow this service to be done by an acupuncturist. Now that I've given that disclaimer, let's address your question.
For the time you spend evaluating and counseling the patient for nutrition and herbal remedies, the most appropriate code would be the evaluation and management codes (99201 through 99205 and 99211 through 99215). According to the 2007 AMA CPT coding manual, when a "physician" is performing medical nutrition therapy, the physician is to utilize evaluation and management codes. In some instances, it may be appropriate to use preventative medicine codes 99381 through 99397. These codes are designated for nonpayment by insurance carriers, but are used to designate the service and are billable to the patient. Therefore, if the nutrition/herbal prescription is preventative and not to treat a specific condition, the preventive medicine codes would be appropriate. Conversely, when a nutrition/herbal prescription is used to treat a specific condition, the most appropriate codes would be for evaluation and management, which are payable to the acupuncture profession.
As far as coding for the herbal supplements themselves, there are no specific codes other than the generic code for nonprescription item A9150. Although it is a billable code, very few insurance policies have provisions for separate payment for supplements and herbs. Therefore, it should and can be billed, but you should have a disclosure to patients that indicates the herbs will most likely be denied as noncovered, and therefore will be 100 percent out-of-pocket for the patient.
