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HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
April, 2002, Vol. 02, Issue 04
Medical Codes for 2002
By Ed Denning, MEd, LMT
When I attended massage therapy school, I was provided limited information regarding medical codes, and part of what I did receive was incorrect. That background is what got me interested in reading and writing about medical codes.
If you used medical codes (CPT & ICD) in 2001, then you will use the same codes in 2002.There have been no changes.
Listed below are some of the codes most frequently utilized by massage therapists. The first list comprises codes that are useable by massage therapists; the second list consists of codes that are not recommended, and explains why they are not recommended.
97010 Hot and cold packs 15 minutes Self-explanatory
97124 Massage 15 minutes Lists specific strokes
97039* Unlisted modality 15 minutes Use of tools
* I include this code only because I know in some states, massage therapists may use devices that mimic massage techniques, or perform allowable therapeutic procedures. This requires constant attendance, and may require a written report and statement of justification.
97139 Unlisted Procedure 15 minutes Therapeutic procedures not covered by 97124 or 97140.
As with 97039, this code may require a written report and a statement of justification.
97140 Manual therapy 15 minutes Therapy not covered by 97124
97001 & 97002 For physical therapy only
97112 Not the code for neuromuscular therapy
97530 An occupational therapy code
99201 For physicians only (has a diagnostic component)
All of the abovementioned codes are derived from two manuals: The International Classification of Disease 9th Edition, Clinical Modification Manual (ICD 9 CM) and The Current Procedural Terminology Manual (CPT).
ICD 9 CM
The ICD 9 CM Manual classifies disease around the world. It is used by health care providers in any country involved in recordkeeping of diseases within the country. These classification codes have a history dating back to the early 1700s, when a French physician wanted to see if he could predict the mortality rate in newborn to five-year-old children. He was quite successful.
The manual is in its 9th edition. It has been highly successful at making statistical comparisons and recordkeeping between countries unified under a single system. It is because of the ICD Manual that we know that the particular diet prevalent one country suppresses the development of cancer, and in another country reduces heart conditions, and so on.
The ICD 9 CM Manual is produced by the World Health Organization (WHO). The WHO has been working on an ICD 10 CM version, which the U.S. will eventually adopt. Versions of the ICD 10 are already in use in Canada and Australia. When it will be adopted in the U.S. is unknown at this time by this author.
Massage therapists are not qualified to select ICD codes. We are allowed to cite them if we have a qualified source. That's why massage therapists need to have a physician's script before they start therapeutic work. Massage therapists who wish to submit billing for insurance need only call the physician of record and ask for the ICD code used. Since the physician's office has a serious vested interest in correct coding, they will be happy to provide you with the correct code.
The Current Procedural Terminology Manual (CPT) is a manual of procedure codes. It was first released for publication in the mid 1960s. Its goal is to describe every medical "procedure" of any kind using a specific number. The CPT codes are now firmly entrenched in the insurance and medical communities. These industries communicate using the CPT and ICD codes. All serious medical practitioners know the codes for their modality of work.
Massage therapists may select from the CPT Manual any code that describes a "procedure" they utilized. You are responsible for the code you choose (or use). Because of the nature of "procedures," many of the codes are highly specific and can only be used by those with training in narrow specialties. The codes tend to be training-dependent. This isn't explained to novices trying to read the manual.
An example is the meaning of the word "physician." In a general dictionary, the word is defined as "a healer." In the CPT Manual, a medical definition is used: "a graduate of a licensed medical school." This is just one of many ways in which an interpreter of CPT codes can get into trouble. Unless you have experience or training that assists you in identifying the vocabulary with specific medical meaning, what appears to be a common word can have an uncommon meaning.
All of the codes that might be used by a massage therapist are in a three-page section of the CPT Manual entitled " Physical Medicine and Rehabilitation." These codes all begin with the digits 97. Any code that does not begin with 97 requires licensure beyond the training level of a massage therapist. Use of a code not appropriate to the licensure of the therapist is considered to be misrepresentation of licensure. Typically such use is referred to as fraud.
Those who do not want us to do coding like to use the "fraud" word prominently. Do you know of anyone personally who has been accused of fraud? Probably not. Nor is it likely that you could be accused of such behavior. To be fraudulent, one must knowingly misrepresent him/herself. If you make an error, that's not fraud.
Did you know that nearly (if not all) auto insurance companies cover massage therapy? Educate your clients! Learn about codes before you need them. Did you know that codes can change from year to year? New codes are added and old codes are dropped. It is the therapist's responsibility to know about such changes. We all need a reliable coding source to save us the frustration of rejected insurance forms due to a coding change.
Have you heard of the Health Insurance Portability and Accountability Act (HIPAA)? The result of federal legislation, HIPAA places a mandate on insurance companies to simplify and expedite insurance submissions. Although no one knows at this time what the repercussions of HIPAA will be for the average billing massage therapist, the law goes into effect by this time next year.
Joining one of the major professional massage organizations means that you are supporting the organizations that protect our future. They represent us in meetings with groups, organizations and at political events. They provide for our safety and protect us from inappropriate legal action. They research and provide services on a national scale. They are a valuable resource for the entire massage community. I encourage you to join at least one.
Ed Denning is a licensed massage therapist in Ohio. He is coordinator of the massage therapy program at Stark State College of Technology, and also serves on the Massage Therapy Advisory Committee of the Ohio State Medical Board.
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