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Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
November, 2004, Vol. 04, Issue 11
By Ed Denning, MEd, LMT
CPT means Current Procedural Terminology. Massage therapists may not use any CPT codes from any area of the American Medical Association (AMA) CPT code manual outside of the physical medicine and rehabilitation pages.The CPT codes massage therapists can use without question are: 97010 - hot and cold packs; 97124 - massage; and 97140 - manual therapy. In my opinion, any other code is questionable and should be avoided unless the user has certifications that have specified the CPT code that represents the procedure they are training you to use.
Codes 97124 and 97140 should not be used to bill for activities within the same session. Most of us could not distinguish when our therapist transitioned between the techniques used in 97124 to the techniques used in 97140 and vice versa. 97001 and 97002 are for physical therapy evaluation; these codes are for physical therapists and should not be used by massage therapists. Their use implies that the user is a physical therapist. 97112 is not the code for neuromuscular therapy; use 97140 instead.
The codes may change from year to year. If you are going to be a user, you will need a yearly updating service to be sure you are current on the CPT codes available for your use.
Distinct Procedural Service
CPT Code Modifier - 59. The purpose of CPT code modifiers is to clarify the activity and intent of the therapist. An example would be modifier -59. This modifier is used to report Distinct Procedural Service. The following example will help clarify its proper use:
A client schedules an appointment for therapy of carpal tunnel symptoms in both wrists and hands. The therapist has confirmed with the insurance company that it will pay for their services. An hour session is scheduled. The work on the right arm and hand turns out to be very slow and detailed, requiring much more time than planned. The session ends with no work having been done on the left arm and hand. An appointment has canceled that same afternoon and the client is willing to return for work on the left side. This would be a new, separate appointment. The work on this arm is completed in an hour with good results.
If the therapist bills 97140 for both appointments with the same ICD code, it will look like double billing. To explain the apparent discrepancy the therapist would code the first session as 97140 and the second session with 97140-59.
Note that the use of the -59 modifier identifies two procedures of similar nature performed on the same individual within a single day or a few days. Using -59 modifier may raise flags with an insurance company and delay payment.
CPT Code Modifier - 52. CPT modifier -52 is for reduced services. Like -59, it is used to help explain what has taken place with one client. Its purpose is to identify and clarify the activities of the therapist. An example will help make its use clear:
The fee for the reduced service unit would be reduced also.
This code is being misused to justify differences between the fees for cash clients and insurance clients. That misuse is the result of a misunderstanding regarding the intent and purpose of the modifier. It is used to explain the time differential between two units of therapy, one of which is shorter than the other. In this case: one client, one two-unit session. The -52 modifier has nothing to do with the difference between the costs incurred with a cash client compared to an insurance client.
Unusual Procedural Services
CPT Code Modifier - 22. This code does not apply to any of the CPT codes massage therapists can use. It is intended for use with diagnostic and evaluation CPT codes, or very specific medical procedure codes. It is designed to report when the usual time period for that procedure is extended due to extenuating circumstances. This modifier will require a report to justify the additional time. Like modifiers -59 and -52, its application is to a single client and a single session.
Using modifiers to justify increased fees to insurance companies is a misuse of those codes and damages our relationships with the medical community and insurance companies. The use of CPT modifiers by massage therapists is seldom appropriate or necessary. The vast majority of us would keep to a schedule of full units, in which the use of modifiers would be for very unusual circumstances only.
Who do you charge the higher fee: A teacher, business executive, factory worker, or sales clerk?
The answer, of course, is that they all should be charged the same fee for the same service. Can you make exceptions? Sure! If I want to give a discount to teachers, I can. All fees charged need to be in a published list available to all clients. If all clients are to be treated the same, what about insurance clients? There are additional expenses involved in dealing with insurance. Unfortunately, there are no administrative or office codes available to massage therapists which we can use to pass on those costs.
A legitimate manner in which to charge a higher fee for your therapeutic services is to have a fee schedule posted that clearly indicates that therapeutic work is billed at a higher rate due to the increased skill level and attention to business details (paperwork). In that case, both the prescribed and non-prescribed therapeutic work would be billed at the same rate. Non-prescribed/non-therapeutic work could have a lower fee.
The difference between the costs of therapeutic-prescribed massage and non-therapeutic massage should not be 100 percent. We are not physicians. A 20 percent difference would be an acceptable and professional differential. The codes that will more accurately represent our services will be forthcoming; we need to practice restraint and patience for now.
An Insurance Company's Response to Coding Abuse
A major insurance carrier in Colorado has restricted all claims by massage therapists to CPT code 97124 and has set a maximum fee that it will pay. The company did this in response to the use of 95 different CPT codes by Colorado massage therapists, for which the therapists charged fees of up to $350 per hour.
Those who abused the system have been punished; however, every massage therapist who must work with that company has also been punished. Some of our colleagues abuse the medical payment system for the short-term gain. In the long term, they damage the massage industry and do harm to the majority of massage therapists who do not allow personal gain to interfere with ethical judgment.
I encourage all massage therapists to join a professional association and to lobby the leadership of their association to take action to educate its members about the legal and ethical responsibilities of coding and billing. It is time for the associations to stand up and protect their membership from the abusive billing strategies being taught at seminars all across the U.S.
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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