Acupuncture pilot in a nutshell

May 20, 2018 1:42 PM | Catherine Dayhoff (Administrator)

WEAMA membership meeting has been a great success and we thank everyone who came out!  Part of our mission for this meeting was to present a cheat sheet for all L&I providers to simplify the documentation requirements. In addition, please take advantage of the online documentation course WEAMA is sponsoring until the end of the pilot. Email us at info@weama.info for your free access code! 

The following information is from our May Membership Meeting, enjoy! 

Labor and Industry – acupuncture pilot in a nutshell

Please inform yourself how to properly document a patient visit for L&I even if you do not currently have a patient with this insurance type. There is specific documentation required for a patient’s first visit.

WEAMA sponsored the online course “How to document for workers’ comp” authored by Megan Kingsley Gale, LAc until Oct 1st, 2019. This sponsorship allows WEAMA’s membership to have free access to detailed documentation course – good for any insurance documentation. Email info@weama.info for a free access code during the pilot. WEAMA thanks Megan for her volunteer work for the board and on the L&I project.

Most important FAQS to familiarize yourself with:

  • 1.     The pilot project was created to see how our profession follows documentation requirements – we have already proven acupuncture works.
  • 2.     Documentation is vital to the success of this pilot and the more professional the documentation the better our profession will be reimbursed in the future especially for E&M codes – provider vs technician. (Workers’ comp online course -> documentation.)
  • 3.     ONLY BILL ONE CODE ONCE PER VISIT-  Use this unique L&I code - 1582M. This code covers a minimum 30 min direct patient care – equivalent to two sets of needles and/or electro-acupuncture. “CPT codes 97810, 97811, 97813, and 97814 are not payable” -- Do not code those CPT codes.
  • 4.     DO NOT REQUEST MORE VISITS. Only 10 visits are approved by L&I – Each time a provider requests more visits L&I finds that our profession cannot follow requirements.
  • 5.     Maximum reimbursement is $107.78. You set your rates to what you want – L&I will not pay higher than $107.78 per patient visit.
  • 6.     Treatments only to be continued if there is documented, measured improvements shown midway through treatments.

Documentation requirements:

            Mail claims: Department of Labor & Industries PO Box 44269

                                 Olympia, WA 98504-4269

            Fax Chart notes: 360-902-4567 – include claim # on top right of each page.

            Email test - Oswestry and Graded Chronic Pain Scale:                                  acupuncturepilot@lni.wa.gov

      1. Initial Visit: *Fax chart notes every time you mail a claim and email tests*

            a. Complete SOAP notes detailed well to code for E&M - Summary of              subjective complaints, objective findings and treatment plan focusing on          functional improvement.  – Use modifier 25 for E&M codes.

            b. Test – Include Oswestry Disability Index filled out by patient at initial visit.

            c. Test – Include Graded Chronic Pain Scale filled out by patient at initial visit.

            d. Test – Preform the Straight leg test etc – rule out any red flags

      2. Fifth Visit:

            a. Test – Include Oswestry Disability Index filled out by patient at fifth visit.

            b. Test – Include Graded Chronic Pain Scale filled out by patient at fifth visit.

      3. Final Visit:

            a. Required addition to chart note – Reason for Discharge of the patient          must be documented, from the following list: Goals met, Lack of            progress, Patient/ caregiver request (self-discharge), Medical              complication, Frequent no show/ cancellation                                                         (noncompliance), Insurance benefits expired, Care transfer (other facility/        level of care), or Other (please describe).

How to find an attending provider to send introduction letters:

  • 1)    Go to www.findadoctor.lni.wa.gov and click on “Search for a doctor or provider.”
  • 2)    Select “All Providers” and enter address or zip code.

Form Letter Draft Introducing Your Clinic to an LnI Attending Provider

DRAFT Author: Megan Kingsley Gale

[your clinic letterhead here…]

Date: ____

Dr.(s) _____ and office staff:

Did you know that you can now have a new non-pharm pain relief referral option for your Workers’ Comp patients who have injuries related to low back pain on their open claim?

In October 2016, Washington State L&I began the L&I Acupuncture Pilot Project.  Workers who have an open claim related to low back pain may be referred for up to 10 treatments with East Asian Medicine Practitioners (Acupuncturists) who have enrolled as approved providers in the Pilot.

I/my clinic am/are one of those Pilot Providers and we are looking forward to receiving any of your patients who have not yet received acupuncture for their injury related to low back pain.

You can contact us/reach us at ________[your clinic information here. Elaborate on your clinic here.]11

Required documents can be found at the following URL:

Oswestry: http://lni.wa.gov/ClaimsIns/Files/Providers/AcupuncturePilotODIformInstructions.pdf

Graded Chronic Pain Scale: http://lni.wa.gov/ClaimsIns/Files/Providers/AcupuncturePilotGCPSformInterpretation.pdf

DVRPS: http://www.asacu.org/wp-content/uploads/2018/03/Combined-One-Sheet.pdf

L&I contacts:

Acupuncture Pilot Information            Zachary Gray, Zachary.Gray@Lni.wa.gov

Acupuncture Pilot Rulemaking Jami Lifka, Jami.Lifka@Lni.wa.gov

Billing and Payment questions  Provider Hotline: 1-800-848-0811