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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
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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