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How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
February, 2012, Vol. 12, Issue 02
Positional Release Self Care for Soreness and Other Pains
By Leon Chaitow, ND, DO
If your patients are anything like mine, they will report to you that there is commonly a degree of discomfort, soreness or stiffness a day or so following manual treatment no matter how gentle or appropriate that treatment might have been.As a result, I offer advice regarding home care of such problems, and I tend to repeat a mantra to most patients who have received treatment for musculoskeletal problems as they depart. I ask them to largely ignore any soreness they might feel the next day. I tell them that it is perfectly normal for there to be an adaptive reaction/response to treatment for a day or so of their knee, neck, or whatever focal point of distress brought them to see me and that it will probably not be until around 48 hours later that they will know whether today's treatment was helpful.
And of course, if your patient happens to have a chronically painful problem, it's highly likely that a degree of sensitization will have occurred, making their responses and reactions to treatment far less predictable and potentially excessive. For more on that subject please see my May 2011 article, "Understanding Central Sensitization"
How common are short-term adverse effects following manual therapy? Bronfort et al (2010), conducted a major review of the effectiveness of manual therapies and it also looked at negative effects: "Adverse events associated with manual treatment can be classified into two categories: 1) benign, minor or non-serious and 2) serious. Generally, those that are benign are transient, mild to moderate in intensity, have little effect on activities, and are short lasting. Most commonly, these involve pain or discomfort to the musculoskeletal system. Less commonly, nausea, dizziness or tiredness are reported."
Carnes et al (2010), also conducted a detailed review of the evidence relating to the safety and side-effects following use of manual therapy modalities and concluded that: "Nearly half of patients after manual therapy experience adverse events that are short-lived and minor; most will occur within 24 hours and resolve within 72 hours. The risk of major adverse events is very low, lower than that from taking medication."
Even in relation to muscle energy technique (MET), one of my favorite modalities because of its extreme versatile efficacy, gentleness and safety, there are commonly minor degrees of discomfort for a day or two following treatment, even when appropriately applied. Greenman (2003) has explained some of the processes leading to post-MET-treatment discomfort: "All muscle contractions influence surrounding fascia, connective tissue ground substance and interstitial fluids, and alter muscle physiology by reflex mechanisms. Fascial length and tone is altered by muscle contraction... The patient's muscle effort requires energy and the metabolic process of muscle contraction results in carbon dioxide, lactic acid and other metabolic waste products that must be transported and metabolized. It is for this reason that the patient will frequently experience some increase in muscle soreness within the first 12 to 36 hours following MET treatment. Muscle energy procedures provide safety for the patient since the activating force is intrinsic and the dosage can easily be controlled by the patient, but it must be remembered that this comes at a price. It is easy for the inexperienced practitioner to overdo these procedures and in essence to overdose the patient."
In other words, when correctly applied, MET will commonly lead to mild discomfort for several days, BUT, when incorrectly applied (contractions too strong, stretching too vigorous, etc.) more severe reactions may result and without the bonus of benefits that correct usage might offer! For more on muscle energy techniques, you can visit my web site, www.leonchaitow.com/muscle.htm.
Are there strategies that you might be able to teach patients to manage this adaptive stage? What else might you offer your patients as self-care for minor reactions to treatment? Depending on the specifics of the individual's problems, a number of options are available, ranging from simple hydrotherapy (hot and cold compresses, ice massage) to relaxation methods, self-stretching (if appropriate) and from my perspective the most potent self-care we can teach patients in pain is self-applied positional release.
Derived from osteopathy, Positional Release Technique (PRT), or that version of it known as Strain-Counterstrain (SCS), can relieve pain by relaxing tight (shortened) tissues and improving local circulation. Unlike massage and stretching, PRT is safe to apply even on damaged or inflamed tissues. If painfully shortened (hypertonic) soft tissues can be gently placed into a position in which they are made even shorter, pain is usually temporarily removed. If that "position of ease" is maintained for a minute or so, the tight, tense muscle (and often trigger points housed there) are likely to release and relax, sometimes permanently, but at least for a while with pain diminishing subsequently.
Try the following exercise, self-treatment of tense suboccipital muscles, and consider teaching it to patients as an example of this remarkable method of self-care. This is adapted from Chapter 5 of my book, Positional Release Techniques.
Patient instructions for suboccipital self-treatment using SCS:
General Guidelines For SCS Self-Care Of Pain Anywhere Else
If a painful point/local area is on the front of the body, bend forward to relieve it; the further it is to one side, the more you should slowly turn toward that side. If the point is on the back of your body, bend slightly backward until the pain reduces a little, then turn away from the side where you feel the pain, and "fine-tune" to release the discomfort. If the point is on a limb, try to shorten the relevant muscles (don't stretch them) by slowly moving the area to find the position in which the pain is most reduced. When there are many areas of pain it is often best to start with those nearer the head and nearer the middle of the body, using this extremely noninvasive and effective form of treatment.
Click here for more information about Leon Chaitow, ND, DO.
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