Author Archives: Amy Crosby

2019 ICD10-CM Updates

AAC AcuCode Digital Coding Update

The 2019 codes have been published and now are included in the AcuCode portal. Note these codes can be found by doing a search with “10-1-2018” and this will provide the codes are that are being added, deleted or changed for 2019 specific to acupuncture providers.

The codes are effective 10-1-2018 and are based on the date of service and not the dates billed. For services on or after October 1, the new codes must be used.

The most prominent and likely common code is for Myalgia which M79.1 was deleted with new codes M79.10 to M79.18

Additionally, there is also a new code for postpartum depression with a distinction from puerperal (postpartum) psychosis

2019 ICD10-CM Updates
71,704 codes in ICD10-CM2018
71,932 codes in ICD10-CM 2019
279 additions
51 deletions
143 revisions

M79.1 Myalgia (deleted 10-1-2018)
New codes
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head, and neck
M79.18 Myalgia, other site
Type 1 excludes (do not code together)
• Fibromyalgia M79.7
• Myositis M60.

F53 Puerperal psychosis (deleted 10-1-2018)
New codes
F53.0 Postpartum depression
F53.1 Puerperal psychosis

G710 Muscular dystrophy (deleted 10-1-2018)
New codes
G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71. 09 Other specified muscular dystrophies

H57.8 Other specified disorders of eye and adnexa (deleted 10-1-2018)
New codes
H57.811 Brow ptosis, right (drooping or falling upper eyelid)
H57.812 Brow ptosis, left (drooping or falling upper eyelid)
H57.813 Brow ptosis, bilateral (drooping or falling upper eyelid)
H57.819 Brow ptosis, unspecified (drooping or falling upper eyelid)
H57.89 Other specified disorders of eye and adnexa

2017 ICD10 Updates

As occurs every October 1 there are additions and deletions to the ICD10 code set.

This year is no different though the codes updating that relate to acupuncture claims are very small if at all when related to common codes. The only common code that updated is lumbar spinal stenosis that now differentiates to indicate with or without neurogenic claudication.

This list compromises the codes most likely to affect acupuncture claims. As always The Digital Coding site allows you to search for updates via a key word search 0-1-2017 for this year (note last year’s changes can be viewed with a search of 10-1-2016 and are included in this list also)

The following codes are being added 10-1-2017 and also 10-1-2016. This list compromises the codes most likely to affect acupuncture claims.

Note the codes in bold will be deleted after 10-1-2017 or 10-1-2016 Note the date of service will determine the code. Visits on or after 10-1-2016 require the updated codes.

October 1, 2017 additions & deletions

  • M48.06 Spinal stenosis, lumbar region (deleted 10-1-2016)
  • M48.061 Spinal stenosis, lumbar region without neurogenic claudication
  • M48.062 Spinal stenosis, lumbar region with neurogenic claudication
  • Z68.1   Body mass index (BMI) 19.9 or less, adult
  • Z71.82   Exercise counseling
  • G12.25 Progressive spinal muscle atrophy

October 1, 2016 additions & deletions

  • F32.81 Premenstrual dysphoric disorder
  • F32.89 Other specified depressive episodes
  • F34.81 Disruptive mood dysregulation disorder
  • F34.89 Other specified persistent mood disorders
  • G56.03 Carpal tunnel syndrome, bilateral upper limbs
  • G56.13 Other lesions of median nerve, bilateral upper limbs
  • G56.23 Lesion of ulnar nerve, bilateral upper limbs
  • G56.33 Lesion of radial nerve, bilateral upper limbs
  • G56.43 Causalgia of bilateral upper limbs
  • G56.83 Other specified mononeuropathies of bilateral upper limbs
  • G56.93 Unspecified mononeuropathy of bilateral upper limbs
  • G57.03 Lesion of sciatic nerve, bilateral lower limbs
  • G57.13 Meralgia paresthetica, bilateral lower limbs
  • G57.23 Lesion of femoral nerve, bilateral lower limbs
  • G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs
  • G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
  • G57.53 Tarsal tunnel syndrome, bilateral lower limbs
  • G57.63 Lesion of plantar nerve, bilateral lower limbs
  • G57.73 Causalgia of bilateral lower limbs
  • G57.83 Other specified mononeuropathies of bilateral lower limbs
  • G57.93 Unspecified mononeuropathy of bilateral lower limbs
  • M26.60  Temporomandibular joint disorder, unspecified (deleted 10-1-2016)
  • M26.601 Right temporomandibular joint disorder, unspecified
  • M26.602 Left temporomandibular joint disorder, unspecified
  • M26.603 Bilateral temporomandibular joint disorder, unspecified
  • M26.609 Unspecified temporomandibular joint disorder, unspecified side
  • M26.61  Adhesions and ankylosis of temporomandibular joint (deleted 10-1-2016)
  • M26.611 Adhesions and ankylosis of right temporomandibular joint
  • M26.612 Adhesions and ankylosis of left temporomandibular joint
  • M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
  • M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
  • M26.62  Arthralgia of temporomandibular joint (deleted 10-1-2016)
  • M26.621 Arthralgia of right temporomandibular joint
  • M26.622 Arthralgia of left temporomandibular joint
  • M26.623 Arthralgia of bilateral temporomandibular joint
  • M26.629 Arthralgia of temporomandibular joint, unspecified side
  • M26.63  Articular disc disorder of temporomandibular joint (deleted 10-1-2016)
  • M26.631 Articular disc disorder of right temporomandibular joint
  • M26.632 Articular disc disorder of left temporomandibular joint
  • M26.633 Articular disc disorder of bilateral temporomandibular joint
  • M26.639 Articular disc disorder of temporomandibular joint, unspecified side
  • M50.20 Cervical disc disorder C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
  • M50.021 Cervical disc disorder at C4-C5 level with myelopathy
  • M50.022 Cervical disc disorder at C5-C6 level with myelopathy
  • M50.023 Cervical disc disorder at C6-C7 level with myelopathy
  • M50.12 Mid-cervical disc disorder C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.120 Mid-cervical disc disorder, unspecified
  • M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
  • M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
  • M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
  • M50.22 Other cervical disc displacement C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.220 Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221 Other cervical disc displacement at C4-C5 level
  • M50.222 Other cervical disc displacement at C5-C6 level
  • M50.223 Other cervical disc displacement at C6-C7 level
  • M50.32 Other cervical disc degeneration C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.320 Other cervical disc degeneration, mid-cervical region, unspecified level
  • M50.321 Other cervical disc degeneration at C4-C5 level
  • M50.322 Other cervical disc degeneration at C5-C6 level
  • M50.323 Other cervical disc degeneration at C6-C7 level
  • M50.82 Other cervical disc disorders C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.820 Other cervical disc disorders, mid-cervical region, unspecified level
  • M50.821 Other cervical disc disorders at C4-C5 level
  • M50.822 Other cervical disc disorders at C5-C6 level
  • M50.823 Other cervical disc disorders at C6-C7 level
  • M50.92 Unspecified cervical disc disorder C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • M50.920 Unspecified cervical disc disorder, mid-cervical region, unspecified level
  • M50.921 Unspecified cervical disc disorder at C4-C5 level
  • M50.922 Unspecified cervical disc disorder at C5-C6 level
  • M50.923 Unspecified cervical disc disorder at C6-C7 level
  • N50.8  Other specified disorders of male genital organs (deleted 10-1-2016)
  • N50.811 Right testicular pain
  • N50.812 Left testicular pain
  • N50.819 Testicular pain, unspecified
  • N50.82 Scrotal pain
  • N50.89 Other specified disorders of the male genital organs
  • S03.4XXA  Sprain of jaw, initial encounter (deleted 10-1-2016)
  • S03.4XXD  Sprain of jaw, subsequent encounter (deleted 10-1-2016)
  • S03.4XXS  Sprain of jaw, sequela (deleted 10-1-2016)
  • S03.40XA Sprain of jaw, unspecified side, initial encounter
  • S03.40XD Sprain of jaw, unspecified side, subsequent encounter
  • S03.40XS Sprain of jaw, unspecified side, sequela
  • S03.41XA Sprain of jaw, right side, initial encounter
  • S03.41XD Sprain of jaw, right side, subsequent encounter
  • S03.41XS Sprain of jaw, right side, sequela
  • S03.42XA Sprain of jaw, left side, initial encounter
  • S03.42XD Sprain of jaw, left side, subsequent encounter
  • S03.42XS Sprain of jaw, left side, sequela
  • S03.43XA Sprain of jaw, bilateral, initial encounter
  • S03.43XD Sprain of jaw, bilateral, subsequent encounter
  • S03.43XS Sprain of jaw, bilateral, sequela
  • Z98.89  Other specified postprocedural states (deleted 10-1-2016)
  • Z98.890 Other specified postprocedural states

 

New Acupuncture Specific Codes Effective 10-1-2016

The following codes have been added 10-1-2016 and are included in this list as the most likely to affect an acupuncture claims and/or conditions. They are listed in Alphabetic/ICD10 order. Codes are in the system and can be viewed by logging in and can be searched by “10-1-2016” in the search bar and it will be bring up all the new, updated and deleted codes.

Visits on or after 10-1-2016 require the updated codes.

  • E78.0 Pure hypercholesterolemia(deleted 10-1-2016)
  • E78.00 Pure hypercholesterolemia, unspecified
  • E78.01 Familial hypercholesterolemia
  • F32.81 Premenstrual dysphoric disorder
  • F32.89 Other specified depressive episodes
  • F34.81 Disruptive mood dysregulation disorder
  • F34.89 Other specified persistent mood disorders
  • F42 Obsessive-compulsive disorder(deleted 10-1-2016)
  • F42.2 Mixed obsessional thoughts and acts
  • F42.3 Hoarding disorder
  • F42.4 Excoriation (skin-picking) disorder
  • F42.8 Other obsessive-compulsive disorder
  • F42.9 Obsessive-compulsive disorder, unspecified
  • F50.8 Other eating disorders(deleted 10-1-2016)
  • F50.81 Binge eating disorder
  • F50.89 Other specified eating disorder
  • G56.03 Carpal tunnel syndrome, bilateral upper limbs
  • G56.13 Other lesions of median nerve, bilateral upper limbs
  • G56.23 Lesion of ulnar nerve, bilateral upper limbs
  • G56.33 Lesion of radial nerve, bilateral upper limbs
  • G56.43 Causalgia of bilateral upper limbs
  • G56.83 Other specified mononeuropathies of bilateral upper limbs
  • G56.93 Unspecified mononeuropathy of bilateral upper limbs
  • G57.03 Lesion of sciatic nerve, bilateral lower limbs
  • G57.13 Meralgia paresthetica, bilateral lower limbs
  • G57.23 Lesion of femoral nerve, bilateral lower limbs
  • G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs
  • G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
  • G57.53 Tarsal tunnel syndrome, bilateral lower limbs
  • G57.63 Lesion of plantar nerve, bilateral lower limbs
  • G57.73 Causalgia of bilateral lower limbs
  • G57.83 Other specified mononeuropathies of bilateral lower limbs
  • G57.93 Unspecified mononeuropathy of bilateral lower limbs
  • H93.A1 Pulsatile tinnitus, right ear
  • H93.A2 Pulsatile tinnitus, left ear
  • H93.A3 Pulsatile tinnitus, bilateral
  • H93.A9 Pulsatile tinnitus, unspecified ear
  • K52.29 Other allergic and dietetic gastroenteritis and colitis
  • K52.2 Allergic and dietetic gastroenteritis and colitis (deleted 10-1-2016)
  • K52.3 Indeterminate colitis
  • K52.831 Collagenous colitis
  • K52.832 Lymphocytic colitis
  • K52.838 Other microscopic colitis
  • K52.839 Microscopic colitis, unspecified
  • K90.41 Non-celiac gluten sensitivity
  • M21.611 Bunion of right foot
  • M21.612 Bunion of left foot
  • M21.619 Bunion of unspecified foot
  • M21.621 Bunionette of right foot
  • M21.622 Bunionette of left foot
  • M21.629 Bunionette of unspecified foot
  • M25.541 Pain in joints of right hand
  • M25.542 Pain in joints of left hand
  • M25.549 Pain in joints of unspecified hand
  • M26.601 Right temporomandibular joint disorder, unspecified
  • M26.602 Left temporomandibular joint disorder, unspecified
  • M26.603 Bilateral temporomandibular joint disorder, unspecified
  • M26.609 Unspecified temporomandibular joint disorder, unspecified side
  • M26.611 Adhesions and ankylosis of right temporomandibular joint
  • M26.612 Adhesions and ankylosis of left temporomandibular joint
  • M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
  • M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
  • M26.621 Arthralgia of right temporomandibular joint
  • M26.622 Arthralgia of left temporomandibular joint
  • M26.623 Arthralgia of bilateral temporomandibular joint
  • M26.629 Arthralgia of temporomandibular joint, unspecified side
  • M26.631 Articular disc disorder of right temporomandibular joint
  • M26.632 Articular disc disorder of left temporomandibular joint
  • M26.633 Articular disc disorder of bilateral temporomandibular joint
  • M26.639 Articular disc disorder of temporomandibular joint, unspecified side
  • M26.60 Temporomandibular joint disorder, unspecified (deleted 10-1-2016)
  • M26.61 Adhesions and ankylosis of temporomandibular joint (deleted 10-1-2016)
  • M26.62 Arthralgia of temporomandibular joint (deleted 10-1-2016)
  • M26.63 Articular disc disorder of temporomandibular joint (deleted 10-1-2016)
  • M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
  • M50.021 Cervical disc disorder at C4-C5 level with myelopathy
  • M50.022 Cervical disc disorder at C5-C6 level with myelopathy
  • M50.023 Cervical disc disorder at C6-C7 level with myelopathy
  • M50.120 Mid-cervical disc disorder, unspecified
  • M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
  • M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
  • M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
  • M50.220 Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221 Other cervical disc displacement at C4-C5 level
  • M50.222 Other cervical disc displacement at C5-C6 level
  • M50.223 Other cervical disc displacement at C6-C7 level
  • M50.320 Other cervical disc degeneration, mid-cervical region, unspecified level
  • M50.321 Other cervical disc degeneration at C4-C5 level
  • M50.322 Other cervical disc degeneration at C5-C6 level
  • M50.323 Other cervical disc degeneration at C6-C7 level
  • M50.820 Other cervical disc disorders, mid-cervical region, unspecified level
  • M50.821 Other cervical disc disorders at C4-C5 level
  • M50.822 Other cervical disc disorders at C5-C6 level
  • M50.823 Other cervical disc disorders at C6-C7 level
  • M50.920 Unspecified cervical disc disorder, mid-cervical region, unspecified level
  • M50.921 Unspecified cervical disc disorder at C4-C5 level
  • M50.922 Unspecified cervical disc disorder at C5-C6 level
  • M50.923 Unspecified cervical disc disorder at C6-C7 level
  • N50.811 Right testicular pain
  • N50.812 Left testicular pain
  • N50.819 Testicular pain, unspecified
  • N50.82 Scrotal pain
  • N50.89 Other specified disorders of the male genital organs
  • N50.8 Other specified disorders of male genital organs(deleted 10-1-2016)
  • N94.10 Unspecified dyspareunia
  • N94.11 Superficial (introital) dyspareunia
  • N94.12 Deep dyspareunia
  • N94.19 Other specified dyspareunia
  • N94.1 Dyspareunia(deleted 10-1-2016)
  • S03.40XA Sprain of jaw, unspecified side, initial encounter
  • S03.40XD Sprain of jaw, unspecified side, subsequent encounter
  • S03.40XS Sprain of jaw, unspecified side, sequela
  • S03.41XA Sprain of jaw, right side, initial encounter
  • S03.41XD Sprain of jaw, right side, subsequent encounter
  • S03.41XS Sprain of jaw, right side, sequela
  • S03.42XA Sprain of jaw, left side, initial encounter
  • S03.42XD Sprain of jaw, left side, subsequent encounter
  • S03.42XS Sprain of jaw, left side, sequela
  • S03.43XA Sprain of jaw, bilateral, initial encounter
  • S03.43XD Sprain of jaw, bilateral, subsequent encounter
  • S03.43XS Sprain of jaw, bilateral, sequela

HIPAA Compliance Audits on the Horizon

Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report's recommendations and that they need to do more oversight actvities.

Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.

Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.

Make plans in the near term to address all HIPAA compliance requirements.

NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR's activities.
See the full report at http://oig.hhs.gov/oei/reports/oei-09-10-00510.pdf

1500 Claim Form Diagnosis Reporting with ICD-10- No Decimals

Reporting Diagnosis on the 1500 with ICD10 should NOT have decimals as they are implied. When reporting diagnosis in block 21 of the 1500 there is a 7 character limit and the use of a decimal will drop the final character of a 7 digit code. Therefore diagnosis on the 1500 should be reported without a decimal and simply the characters with no spacing.

Note the following examples of 3, 4, 5, 6, and 7 character codes.

R51, M545, M5431, M25511, MS134XXA

NUCC 1500 Claim Form Manual

http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v3.pdf

 

ITEM NUMBER 21

TITLE: Diagnosis or Nature of Illness or Injury

INSTRUCTIONS:

Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field.

Enter the codes left justified on each line to identify the patient’s diagnosis and/or condition. Do not include the decimal point in the diagnosis code, because it is implied. List no more than 12 ICD-9-CM or ICD-10-CM diagnosis codes. Relate lines A - L to the lines of service in 24E by the letter of the line. Use the greatest level of specificity. Do not provide narrative description in this field.

Be Aware of Credit Card Fees

Many providers accept credit cards as a form of payment, but need to be aware of the associated fees when accepting virtual credit card payments from insurers for reimbursement purposes. Virtual credit cards are unique card numbers generated for a specific one-time transaction and linked to real accounts with card issuers. Clinics need to be aware that these transactions carry significant fees compared to traditional forms of payment--up to five percent of the transaction amount--and may include additional fees to offset fraud risk when card numbers are entered manually, which in effect reduces reimbursement to the clinic. It also effectively transfers the cost of the transaction from the payer to the clinic.

Acupuncture Timed Service Documentation Requirements

The 15 minute increment of time is defined as personal one-on-one contact with the patient. This means that the physician acupuncturist is in the room with the patient, is actively performing a medically necessary activity that is a component of acupuncture or electro acupuncture. The time that the needles are retained is specifically excluded for the purpose of determining time and consequently from reimbursement. 8 Minute Rule for Timed Codes – One Service

For services billed in 15-minute units, count the minutes of skilled treatment provided. Only direct, face-to-face time with the patient is considered for timed codes. 8 minute time rule for timed service

• 7 minutes or less of a single service is not billable.

• 8 minutes or more of a single service is billable as 1 unit or an additional unit if the prior units were each furnished for a full 15 minutes:

• 8 – 22 minutes = 1 unit

• 23 – 37 minutes = 2 units

• 38 – 52 minutes = 3 units

• 53 – 67 minutes = 4 units

The face-to-face time can be identified as pre-service work which includes greeting the patient and a brief interval history. Intra-service work for actions connected to the acupuncture procedure which may include pertinent evaluation and assessment of the patient (tongue, pulse, palpation, ROM etc.), hand washing, patient positioning, locating and cleaning the points, inserting and stimulating the needles, checking on the patient, removing the needles, and any discussion or counseling related to the acupuncture service. The face-to-face time does not include needle retention time where there is no need for direct patient monitoring or contact.

Documentation and Proper Billing of Physical Medicine and Rehabilitation Services

Modalities (e.g., heat, mechanical traction or ultrasound) are generally coded and billed based on the device that is used.

Therapeutic procedures are generally coded and billed on the basis of the intended outcome, not on a device or piece of equipment. For instance therapeutic exercise, 97110, is intended to increase strength, flexibility, and/or endurance while neuromuscular re-education, 97112, is to restore balance, coordination, proprioception, kinesthetic sense etc. The movement or activity can be very similar in these services and as a consequence the proper code to represent the service will depend on the outcome or purpose of the service.

When billing and coding for therapeutic procedures, document the intended clinical outcome, as well as how the procedure is performed. Bear in mind that the documentation should indicate a relationship to a functional improvement and activity as a result of care.

For example: Increase flexibility of the lumbar paraspinal muscles, while activating and stretching the hamstring muscles, to improve the patient’s capacity for walking and standing. This relationship can be easily documented as part of the subjective and objective sections of the chart notes.

Current Procedural Terminology (CPT)

Sometimes we get asked the difference between diagnostic (ICD) and CPT codes. Both codes sets are used to standardize medical communications across the board, but ICD codes focus on the diagnosis, whereas CPT coding identifies the services provided. Understanding how to properly use CPT codes is really critical in helping achieve prosperous reimbursement because insurance companies use these codes to determine how much an acupuncturist will be paid. The CPT section in AcuCode Digital Coding is a very helpful tool in helping not only select, but really understand the appropriate code to use. Digital Coding has three specific acupuncture CPT sections: evaluation and management; physical medicine and rehabilitation; and acupuncture. Did you know that misuse of a CPT code is the #1 trigger of an audit by an insurance company? All the more reason to make sure you are using the right code, the most updated code, and are knowledgeable how to apply CPT to an acupuncture practice.

ICD-10 Feet Dragging is the Norm

If you are still on the fence about ICD-10 coming to pass this October 1, 2015; you're in great company. Workgroup for Electronic Data Interchange finds that in a survey of over 1,100 physician players and vendors the biggest obstacle to industry readiness is the assumption that another delay will occur. In fact, we at Digital Coding were on the fence not too long ago also. With year-after-year of constant delays we don't blame anyone for dragging their feet on installing a transition plan. After carefully following lobbying efforts monitoring what the "big guys" such as medicare and the AMA are up-to, it seems that there is no longer enthusiasm for another delay, but rather a readiness for the transition to finally take place. Our friends at MedPage report that Barbie Hays, coding and compliance strategist for the American Association of Family Physicians says that "At this point it would need a presidential mandate for this to stop and I don't think that is going to happen." We certainly agree, and our own billing expert Sam Collins cautions to not wait until the last minute to devise your plan. The time is now to start looking at the new codes and getting your acupuncture practice in shape for the transition.