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Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
July, 2005, Vol. 05, Issue 07
Medical Conditions in Massage Practice, Part II: The Client in a Physician's Care
By Tracy Walton, LMT, MS
Thanks to better training and texts in the field, massage therapists tell me their knowledge of contraindications is growing. But many report gaps in knowing how to interview for contraindications and how to apply the answers in the session.In part one of this series, I wrote about my early attempts at interviewing and how that changed over time. I also offered an interview question - about client activity level and types of activities - with examples of the kinds of important information it can bring to light for the massage session (June 2005, www.massagetoday.com/archives/2005/06/04.html).
These articles offer all-purpose questions for the massage interview and examples of using the client's answers in massage design.
The task of interviewing clients for contraindications feels easy for some therapists, harder for others. Some tell me they rush through it to get to the hands-on session; others like to take their time. The massage setting can also influence the interview. In private practice, we have as long as we are comfortable scheduling with the each client. Many therapists allow an extra 15 to 30 minutes for a first-time session. In contrast, most spa and other high-volume settings (on-site, sports events, fundraising walks, etc.) allow for very little information gathering. Years ago I worked in a spa where we were taught to limit our intake to one question on the way from the greeting area to the treatment room: "Is there anything I should know about your health?" Many spa practitioners tell me this is still the limit of their questioning.
The problem with this question is that clients don't usually know what we're looking for or which health conditions are important to massage therapists. Indeed, some frustrated massage therapists tell me that they don't always know what they're looking for either. Our pathology and clinic training doesn't always prepare us for gathering information quickly, easily and thoroughly in a range of massage settings. From massage therapists I meet around the country, I am learning that given lists of contraindications, massage therapists don't always know how to interview for them. Given lists of interview questions, we are not necessarily taught how to use the answers.
As the profession develops, we will grow to understand our interviewing tasks more fully and be able to adapt them to the special challenges of different massage settings. I am confident that we will standardize brief, efficient interviews and protocols for higher-volume settings and more extensive intake practices for other settings. For now, here are some "umbrella" questions to ask every client, which should be added to any interview regardless of the setting in order to get a good health picture and design an appropriate massage for each person.
Are you currently (or have you recently been) in a physician's care?
For those in high-volume settings without forms or record keeping, this is a question to ask on the way to the table. Even if your setting allows forms and ample interviewing time, ask this of everyone. If your intake form includes a list of specific conditions, this is a good all-purpose question to catch any that are not listed. It might prompt a client to remember something he/she forgot to mention elsewhere on the form. Then you can apply appropriate massage contraindications.
This question leads to the first, most obvious follow-up question: "For what condition or complaint have you been seeing them?" Here you are looking for the diagnosed condition to determine massage contraindications and for the complaint that may have brought the client to the physician in the first place. For example, suppose a client has chronic acid reflux or constipation for which she is seeing a physician. If there are no specific questions on your form about digestion and elimination, the physician question may capture this. Reflux might dictate a change in the massage position - a surface slightly inclined toward the head - or bolstering in the side-lying position. Constipation, depending on the cause, may indicate reflexology or acupressure techniques, or even gentle abdominal strokes or contact.
Another, broader follow-up question might be, "Are you seeing any health practitioner regularly?" to spot conditions the client may be bringing to a chiropractor, acupuncturist or movement practitioner, for example. Here you might find out about his/her acupuncture treatment for headaches, dental treatment for TMJ, or chiropractic treatment for a chronic low-back injury. Answers can lead to collegial conversations with these professionals and to proper timing and coordination of treatments.
I know acupuncturists who ask their clients to let acupuncture "sit" for a day or two before following with other treatments such as massage. Massage therapy can be a useful adjunctive therapy for TMJ. The chiropractor would benefit from knowing the massage therapist's approach to the client's low-back issue. And in each of these cases, there might be contraindications or indications to massage therapy depending on the cause of each condition. If a number of diagnoses are possible, massage should be tailored to the most conservative of these: If doctors are looking at either arthritic changes or bone metastasis as a cause of pain in the low back, treat the area as though bone metastasis were the cause and avoid pressure and joint movement in the area until proven otherwise.
"What kind of diagnostic procedures are you undergoing (have you recently undergone)?" is another direction to go. The diagnostics question is useful for several reasons. It tells us what the client's other health care providers are concerned about: tumor as a cause of headache; fibroids as a cause of low back pain; stress aggravating stomach ache. This information is useful without memorizing lists of diagnostic tests. Instead, ask the client what is being investigated, and why. While some clients are more knowledgeable about their care than others, this question may yield clear contraindications or indications to massage. Massage therapists don't necessarily need to go to nursing school or medical school to understand their clients' medical status - they just need to figure out what other care providers are concerned about, then investigate their own field for any adaptations for massage.
Finally, a compelling reason to ask about a client's diagnostic procedures is simple interest in the client's life. Put simply, diagnostics are stressful. Sometimes painful, often requiring awkward positioning or holding still, some procedures aggravate muscle tension that we may be well equipped to relieve once we've followed suitable precautions. The long wait between test and result can be difficult, depending on the nature of the test and possible diagnosis. Our clients' experiences of their medical care can tell us not only where to avoid massage but also where to focus it and how to listen. I once worked with someone who had an MRI for a knee injury the day before. She was awaiting word on whether to have surgery. The MRI was hurried and the technician neglected to tell her when the test was starting. It began before she was comfortably positioned, and she had to hold perfectly still for 20 minutes. Already frazzled, this experience left her more worn out with tension in her hips and low back. The wait for the doctor's call was an anxious time. Careful massage of tense muscles and a listening ear helped her cope as she waited for word on her immediate future.
We handle the human body with care and attention, but we also interview with care and attention, which is as therapeutic as our hands-on services. We ask about another's experience of their body. Questions about their health care tell us something about the texture of our clients' days. These small questions ask, "What is it like to be you?" which can, in and of itself, be healing. A client's answers are as useful to our massage design as our own palpatory cues. At the same time, they can deepen our understanding and the compassion we bring to our work.
Editor's note: Look for part three of Tracy's series in the August 2005 issue.
Click here for more information about Tracy Walton, LMT, MS.
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