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TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
April, 2003, Vol. 03, Issue 04
CPT Codes: To Use, or Not to Use?
By Ed Denning, MEd, LMT
CPT Codes 97001 and 97002
97001: Physical therapy evaluation
97002: Physical therapy re-evaluation
I wrote to the American Medical Association (AMA) Information Services Committee in 1998 regarding the use of 97001 and 97002 by massage therapists.The committee's first response left room for wide interpretation. In April 2002, I wrote a follow-up letter that resulted in the following response:
This response states clearly that only physical therapists are qualified to use these two codes. Massage therapists should not use these codes unless they are physical therapists by licensure; even then, such use would be under the restrictions of the physical therapy licensure of the state in which they practice.
The AMA writes and produces the only CPT manual used in the U.S., and are the final arbiters of a given code's meaning. In this case, its initial explanation was later corrected/modified, resulting in a recommendation against use by massage therapists. This is why your coding information needs to be updated annually. Codes can and do change in meaning and interpretation; new codes are added, and old codes are deleted.
CPT Code 97112
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement; balance; coordination; kinesthetic sense; posture; and proprioception.
In March 2001, I wrote another letter to the AMA Information Services Committee regarding CPT code 97112, requesting the following information:
The AMA response included the following:
Massage therapists certified in PNF stretching can use this code to report that service; certified Hellerwork practitioners also can use this code to report their work. Massage therapists might interpret their ability to desensitize as fulfilling another aspect of this code. Such an interpretation may or may not result in payment and would be stretching the intention of the code. This code is definitely not referring to neuromuscular therapy in any way. The majority of massage therapists should not use this code.
CPT Codes 97124 and 97140
97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).
97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.
In March 2002, I wrote a letter to the AMA Information Services Committee seeking the following information:
The AMA response follows:
My Interpretation of Codes 97124 and 97140
97124 is for increasing circulation and to promote tissue relaxation to the muscles. The specific techniques involved would be effleurage, petrissage and/or tapotement. This code is reported in units of 15 minutes. If your treatment is based on or consists of a basic relaxation massage (Swedish massage), this is the code to use.
97140 is used to describe therapy which increases active pain-free range of motion, increased extensibility of myofascial tissue and facilitates return to functional activities. This code is reported in units of 15 minutes. This code would be used for the techniques stated. It would include neuromuscular therapy, positional release, stretching and nearly any therapeutic technique performed manually for the purposes mentioned in the first sentence.
Caution: There are coding strategies going around which have the apparent purpose of billing for higher amounts of money by using multiple codes to describe the therapy session. Such coding decisions are not that difficult to make. What did you actually do in the session? How many units of time did you spend doing 97124? How many units of time did you actually spend doing 97140? Could a client tell when you had transitioned from one treatment code to another?
Do your clinical notes reflect the techniques for which you are coding? Can you justify your billing by clear delineations within your clinical notes? What was actually performed within the session determines the billing that takes place.
I believe that the vast majority of massage therapists cannot justify the use of 97124 and 97140 within a single treatment session, based on their clinical notes. If you choose to bill using multiple codes, you will need to spend a considerable amount of time writing clinical notes to support your billing practices.
CPT Code 97530
Therapeutic Activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. I wrote yet another letter to the AMA requesting the following information:
The AMA response included the following paragraph:
This code is not recommended for use by massage therapists. Dynamic activities to improve functional performance refers to a series of movements to perform specific functions. The series of movements is therapeutic in nature; it is planned and specific.
An example would be a series of movements designed to gradually increase flexibility, strength and coordination through the use of graduated weights. The action is designed to simulate related activities such as picking up a plate and lifting it up into a cupboard, picking up a hammer and placing it in another location, etc.
97530 is a code used to report a series of movements involving flexibility, strength and coordination specifically designed for recovery of everyday functionality. This code is intended for use by occupational therapists who receive the specific training needed to design therapeutic activities. If you have not received that specific training, you should not use this code. (A weekend seminar is insufficient.)
Editor's note: Mr. Denning notes in his article that billing codes are subject to annual change, and as Massage Today reported recently, new codes specific to alternative therapies are in the works. If you are currently or plan on using codes to bill for services, do your homework!
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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