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The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
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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