In my last video, I spoke about the increasing demand for physical therapists and the importance of understanding Trigger Point Dry Needling (TPDN) CPT codes 20560 and 20561. Today we're delving deeper into this topic by going over tips on how to handle TPDN codes. To learn more about what CPT codes and dry needling are, you can check out my last video! But for now, let’s get into the tips and tricks on how to handle working with these codes.
We are going to first quickly review what each of these codes stands for. CPT code 20560 covers needle insertion without injection in 1 or 2 muscles, while CPT code 20561 also covers needle insertion without injection but focuses on 3 or more muscles. It’s important to note that both of these codes exclusively deal with chronic lower back pain (cLBP).
Now, when coding for dry needling, you need to be mindful of a few things. Firstly, don't include dry needling when you're using manual therapy codes, like CPT code 97140, or neuromuscular re-education codes, which fall under CPT code 97112. Keep these separate to ensure accurate billing.
And here's a crucial heads-up - avoid the temptation of "treatment bundling." This could lead to billing fraud. Always double-check to ensure your codes aren't overlapping inappropriately.
Now, let's talk about acupuncture and how this differs from TPDN. This difference can save you from making coding mistakes, and thus, claim denials.
Although both acupuncture and TPDN use dry needles, they're not one and the same. If you're using TPDN codes 20560 and 20561, just remember you can't perform acupuncture using these codes, too. Even if the points on the body coincide and are done at the same time. Acupuncture is a separate service, and it's usually licensed separately from physical therapy practices in most states.
And sometimes, TPDN codes aren’t covered by health insurance at all. When it comes to reimbursement for these kinds of codes, you might encounter terms like "non-covered service" or "not medically necessary service." Note that a non-covered service simply means it's not paid because it doesn't fall under the patient's plan. On the other hand, a "not medically necessary service" suggests the service provided isn't recognized, effective, or is experimental with unproven effectiveness.
Another helpful tip to know is that the explanation of benefits (EOB) or electronic remittance advice (ERA) will not place responsibility for a “not medically necessary service” on the patient. So if you see TPDN falls under this category, do not provide it to your patients. Unless you want to pay out of your own pocket! If you aren’t sure if your payer pays for TPDN services, check their outpatient rehabilitation services policy. You can also look at their trigger point injection policy, as well.
While there is a huge, upcoming demand for physical therapists, this also means that there's an equal demand for experienced medical billers. Knowing the correct CPT codes to use for these physical therapy services is important. Especially those related to dry needling and acupuncture. Understanding these nuances is crucial for a successful and ethical practice. If you’d like to learn more about physical therapy CPT codes, reach out to Etactics. And you already made it this far into the video, so you might as well like it, share it, and comment below.
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