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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.
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.
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.
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 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.
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...
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!
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.
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."
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.
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.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
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.
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.
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.
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.
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."
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.
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.
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.
May, 2011, Vol. 11, Issue 05
CPT Codes Revealed
By Vivian Madison-Mahoney, LMT
I have received many, many questions (via email and phone) regarding CPT (Current Procedural Terminology) Codes and massage therapists. This article is intended to help answer some of those common questions.In particular, I've been asked numerous times about a massage therapist's ability to use CPT Code 97140 (Manual Therapy Techniques) versus a physical therapist's ability to use it.
97140 Vs. 97124
The CPT Code Book definition of 97140 is: "Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes."
You may also document myofascial release using this code. Most of us perform more than just basic Swedish massage when providing treatment to medically prescribed cases with a written prescription from the treating physician indicating diagnoses, duration and frequency. However, if what you perform is basic Swedish massage, then use CPT Code 97124.
CPT Code 97124: "Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)."
Often insurance companies will deny the massage practitioner the use of 97140, stating that it is a "PT Code" (i.e. physical therapy) and therefore, not in "your scope of practice". This is not true if you have training in myofascial release, manual therapy, manual lymphatic drainage, manual techniques such as neuromuscular therapy, structural alignment or other deeper tissue techniques, and if your training is sufficient to benefit the patient's medical condition. If you can stand up in a court of law and explain what you do, how you do it, why you do it and how it benefited the patient, then feel free to use 97140. If not, be safe and stick with basic Swedish massage, CPT 97124. These are the determining factors, and should never be whether or not it might pay more.
Documentation is the key. With 97140, one must document the region (in conjunction with the prescribed diagnosis), exactly what was performed, and the time spent on each body area (e.g., 15 minutes). Remember when we are billing insurance, we follow the CPT, ICD-9 and other insurance-related rules and regulations. Fifteen minutes is 15 minutes, not 8 minutes or other Medicare rules. This is the same information I provide to fraud investigators and insurance adjusters when they have invited me to do presentations for them.
Please note the following statement is taken straight from the AMA CPT Coding Manual (2011 ed., located in the introductory pages). This is the same information that I use to help many massage therapists across the country to be paid on denied claims for using CPT Code 97140.
Current Procedural Terminology
About 97001: Initial Evaluation and 97002: Re-Evaluation.
It is suggested these codes be used by PTs even though the CPT Code Book states no codes are for any specific provider group and even though massage therapists across the nation are using this code, I highly suggest (based on information received from the insurance industry) that for now we not use these codes.
The reason we suggest not using 97001 and 97002 is because in the CPT Code Book it is followed by codes specifically for Occupational Therapy (97003-97004) and then for Athletic Training (97005-97006), thus indicating the codes are specific to those licensed in those professions. Had there been only the 97001-97002 codes, it might be different.
About 97799: Unlisted Physical Medicine Procedures and/or Rehabilitation.
This code is required to be submitted BR "by report". Massage therapists providing an initial evaluation/assessment should have a sufficient report in the first place. There is also not a fee schedule for this code so ask an insurance adjuster in advance.
I hope all of this information helps you to better understand these codes. Just know that insurance adjusters are not trained in our type of work therefore are looking for (and have the right to ask for) additional information prior to reimbursement of claims. This is for the protection of policyholders as well.
Get Proper Training
One more note on insurance reimbursement. Billing insurance for reimbursement is much more than knowing a code and having a specific form; it is about knowing the guidelines inside-out and upside-down. Get proper training just as you did in order to provide hands-on services. Training and licensing is to "protect the public". Since we are treating ill or injured people and billing for payment from their insurance monies, consider knowing insurance billing for the same purpose: to protect the public as well as yourself.
Click here for more information about Vivian Madison-Mahoney, LMT.
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