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Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
July, 2008, Vol. 08, Issue 07
Ligaments vs. Discs
By Ben Benjamin, PhD
Q. How do you tell the difference between a disc and a ligament injury?
A. Disc and ligament injuries present differently in the following areas: nerve-specific weakness, asymmetrical limitation of movement, distal reference of pain, one-sided pain and reflex changes.
The answer to this question is complex. It's a physician's role to accurately diagnose which type of injury is present. The more knowledge you have, the better - but it's not necessary to be able to make such a diagnosis. Below are some areas you should be cognizant of when someone comes in with neck or low back pain.
Different movements of the arm and hand are controlled by different nerves. For example, resisted extension is enervated by the C7 nerve, resisted flexion primarily by the C6 nerve and resisted medial rotation by the C5 nerve. Therefore, if a nerve root is compressed by a protruding disc at the C7 level, the triceps will be weakened. If the C6 nerve is compressed by a disc, the biceps will be weakened, and so forth. If there is only a ligament injury, the muscles will not be weakened.
Distal reference means pain is referred peripherally. For instance, the pain from a nerve compression in the neck usually is felt in the lower arm and hand. With a ligament injury, the pain usually is felt more proximally, which in the case described, would mean the pain is located near the neck in the shoulder, upper arm or upper back.
Asymmetrical limitation means the person can move in one direction but not in the opposite direction. For example, the person can rotate the neck to the right, but is very limited in rotating the neck to the left; or the person can bend forward at the waist easily, but can't bend back. When a disc is affected, the pain does not switch from the right to the left; it stays on one side. In cases of ligament injury, it's common for the pain to switch from one side to the other. Pain also will come and go with a ligament injury, but not with a disc injury.
Reflexes in the arm or leg diminish with disc injuries but do not with ligament injuries. Similarly, disc and ligament injuries cause different types of numbness and disturbances in sensation.
As with most diagnoses, a practitioner needs to know the complete range of a patient's symptoms in order to make sound conclusions about their injury and appropriate treatment. In the case of disc and ligament injuries, it is easy to mistake one for the other in the absence of the appropriate knowledge. For more information, see www.benbenjamin.com, Neck and Low Back Series.
Click here for more information about Ben Benjamin, PhD.
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