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Is 2025 the Year of Telemedicine Again? Dr. Sam Collins

I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi there friends, it’s Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and most importantly, you as a profession and as an individual provider. As always, we want to make sure you have the most current information to make sure your practice is thriving. And actually just making more money, if you will, or continuing to make more money is our hope.

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I always want to keep you updated first of the year on what’s changing, what’s new, and there’s been things that are changing for this year regarding telemedicine. Now, I know you’re thinking, is telemedicine something that we do a lot of? Maybe not, but I want to point out there’s going to be a place for it.

So I think it’s important to know what these new codes are. So let’s go to the slides. Let’s talk about telemedicine for 2025, because there was a whole new brand set of brand new set of codes in the old system. And when I say old system for 2024 earlier, when we built telemedicine, it was always for. E& M codes.

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And then we build with a modifier 25. That has changed. For this year, they’ve updated. But let’s make sure first that we define what telemedicine is. Let’s make a clear definition. Telemedicine means that the provider uses interactive audio video telecommunications between you and the patient, which means literally a live visit.

It’s just audio video. That’s all just live. So in other words, it is a face to face visit. It’s just a face to face visit done online. I think that’s very viable in this day and age. And I think, though, that really started during the pandemic. I think it’s really stuck because we’re going to move that way anyway.

Think of how often with a medical provider, This is going to save a ton of time because how many of us have been to a medical provider? They don’t touch you. They just sit on the other side of the room. Shoot We should have done that audio video better for everyone. That potentially could fit for us as well in certain circumstances But do remember it’s live audio video and here’s probably the bigger Sticking point for many of you because you’re thinking oh good.

I’m gonna do herbal consults across the nation I’m going to, I’ll slow down. You have to have price, proper licensure. And it says here, make sure you are licensed both in the state where you are located, obviously, but also where the patient is located. So by example, if you’re in California and you’re trying to do a telemedicine visit for someone in Texas or New York or someplace else in California.

You not as a licensed acupuncturist. Now, this is irregardless of if you’re billing insurance, frankly, because you cannot practice in a state you’re not licensed. If you’re saying you want to do some type of herbal consult outside of your state, you’re not doing it as an acupuncturist, you’re doing it as an individual, which means you have no protection.

You’re not, you don’t have malpractice, something goes wrong, it’s on you. I’d be very careful of that. The key factor here is, I think if you’re going to do this, do it for patients that are here because Maybe they have difficulty coming in. Maybe your first visit is going to take an hour because there’s so much information you’re going to do a long consult with them.

Telemedicine might bridge that, so that way when they come in the office, you can get right to it. And or, maybe they don’t have that much time. What about a patient that goes I can’t get off work until this time, I can’t be there. Okay, let’s do some of it, telemedicine. So here’s what’s changed for 2025.

We have some brand new codes and you’ll see these codes. It’s 9800 through 98007. And what these are for. is telemedicine, but you’ll notice they are E& M codes. You’ll notice it says, Synchronous audio video visit for the evaluation management of a new patient, which requires a medically appropriate history and examination.

Straightforward in nature. That’s literally the same thing as an E& M code, except it says synchronous. So in other words, think of these just like E& M codes. 9 8 0 0 0 will be a 9 9 2 0 2, the next one a 4, 0 5. And so much the same way, and I think the easiest way to see these is it’s going to be based on time.

A 15 minute audio video visit, 9 8 0 0 0. 30 minutes, the 0 1. 45 minutes, 02, 60 minutes, 03. And I do think you want to caution that it’s not always going to be about medical decision making, though it could be, which exams mostly are. But if you’re doing a telemedicine with a patient and it takes an hour because of all the information, is it appropriate to use 98003?

Absolutely it is. So don’t be afraid to use it, but document it the same way. You’re going to document I spent one hour over audio video. Tell me the system you use. Tell me the date and time, but you don’t record it. You don’t have to save it somewhere. And it’s going to be all the information you take.

And it’s going to be the same stuff you would take down if they were sitting in front of you. Their history. And maybe some of the evaluation. Now when I say history, realize that’s going to include past history, family history, review of systems, all that stuff. But can it include some exam things? I think at least some.

Could you do potentially a tongue evaluation over audio video, get it close enough to the tongue? Probably. I’d be worried about color a little bit, depending on the cameras, but I think we’re okay. Could you certainly do a range of motion? I think so. Now, could you do tongue and pulse and body palpation?

No, but I think this visit often is going to be one based on a lot of counseling, a lot of history and information. So these are new patients. And these are established patients. They work the same way, just about time. I think time is the more likely use. Here’s the difficulty. How much has this happened in your practice in the last year?

If you’re saying none, it’s probably going to happen none this year, because I think we have to promulgate this. I would say, let’s say you have a patient, they’ve had a car accident, they’re coming in from a medical referral, and you talk with them and you say, hey, we’re going to have to block an hour. for this.

And the patient, Oh, I don’t have an hour. I don’t have an hour until I can come two weeks from now. I don’t want to wait two weeks. Let’s do an audio video. Let’s start there. Now you may wonder what is the value of these? They’re much like the value of a regular E. N. M. They’re slightly less. And by the way, next month we’ll do a program.

The program I do will be on our views. So we’ll go over that. But I’m gonna tell you, it’s roughly 80 percent of what you would build your normal E. N. M. S. There’s no modifier necessary because there’s no treatment. It’s just this visit and what if a visit where the patient’s calling and just goes, you know what?

I need to discuss with you. I’ve got these issues. This visit could be counseling. These could fit. I would just be mindful. Make sure it’s a plan that covers exams. Here’s one of the problems we’re having for acupuncturists. A lot of the plans that you have joined as a provider, you wind up getting into a contract that says we don’t cover exams.

Now, that doesn’t mean you shouldn’t do them. They’re just saying they bundle it and don’t pay it separately. I know a lot of you know what I’m talking about. That’s an upcoming show as well. Anyway, what my point is that be careful. If they’re not covering an E& M code, they’re not going to cover this.

So it’s got to be a plan that covers an E& M, but I do think this is reasonable in some instances. Realistically though, let’s talk about acupuncture. While I love the availability of this service and the potential to use it, I think there’s a place for it. Is that the way we really want to treat someone?

Is that how we’re going to make them better? Let’s face it, in acupuncture, what you do is hands on. You get in the room, you put in needles, because without needles, you can’t talk me into feeling better. Sorry, give me some advice. But the reality is it’s the acupuncture, it’s what you do, but this can be a bridge.

So focus really on the acupuncture part, but this bridge might work for some, I can tell you major carriers, Anthem, Cigna United Healthcare, they will cover this. Just, again, go back to wait a minute, what does my contract say if I’m part of ASH? Maybe not. Now, there’s also new codes for 2025 for telephone calls.

Now, I say telephone calls, actually, what these are called are synchronous audio visits. Now, the reason I say telephone calls is because I’m old. Young people think, no, I don’t need a phone. You can do it through lots of devices. And so realize, though, it does mean just audio only. Now, these work in the same way as the old phone call codes.

And let me be clear. Remember those old codes for phone calls that you had? 99441 and so on? Those are gone. They don’t exist. But let me be conscientious when it comes to a phone call. Phone calls aren’t very typical. Because phone calls are difficult. A phone call that results in a person coming in for a visit or has been seen within the previous 7 days.

is one that they’re not going to cover. And so make sure we understand that. But they are straightforward. 15 minutes, 30 minutes, 45 minutes, or an hour. Okay? That’s a new patient. We have telephone audio visit here for established patients. You know where this probably works though? You have a patient you’ve treated.

It was two weeks ago. They call you and go, oh my god, it’s killing me. And you spend 30 minutes on the phone and they can’t come for the next month because they’re going to go out of town. That could work. Now notice the scenario I gave because if the result of this phone call is a visit is being appointed, then it becomes part of the visit.

So phone calls aren’t going to be well paid because let’s face it, no one’s going to call. You’re going to go, Oh, just do these acupressure points. I’m not saying you won’t do that. Chances are you want to get them in for a visit. So I point this out because it’s important to know, because you’re going to hear people saying there’s codes changed.

And it’s true, but we have to look at what’s the viability of use for us as providers. Is it really viable? And I would say for most of these, in this sense, probably not. It even applies to this new one, which is called a virtual check in. I had someone the other day as acupuncturist, that’s why I decided to do this.

I want to use this code because the patients are sending me emails. A check in is not an email. A check in is when you have an electronic health record system. That’s protected HIPAA compliant, where the patient logs into their account and then checks in with you with some information that maybe you’re communicating back and forth.

You can tell now, that’s probably not viable. One, I don’t know of a system that’s out there for us that does that. Some medical ones do, but the ones for accus, I don’t see that too often. I’m not saying if you have one that does, great. The problem is going to be, notice it says, provided within the previous seven days or procedure within the next 24 hours.

So in other words, if the result of this is again, treatment. Or, was within seven days of a prior visit? Does not count. So being mindful here, when it comes to use of these, do they really match? Because chances are when someone does a check in or a phone call, what is it going to result in? The person coming in for a visit.

So let’s be careful of being overzealous, but focus in on what we do well. What is the reason that people come to you to receive acupuncture if you could talk them into feeling good? You would have done that already or they wouldn’t need to see you It’s the acupuncture where I think this is helpful is to understand that there can be a bridge Particularly the audio video one that helps the phone call thing or you know The audio only is what I think it helps to get them in the office in that few minutes of counseling though You’re not billing for it directly Indirectly, it’s creating that good patient doctor relationship.

They trust you and you’re giving them solid information. The good news is, your practice continues to thrive. Next month when we go over RVUs, I’m not sure you’re aware, do you know your fees for the first set raised 20%? And that’s where I want to make a focus. So as always, we want to be the place where you get the right information.

The American Acupuncture Council has a very vested interest in all of you. Please make sure you continue to practice well, but I also want to make sure you’re profitable. If you’re not already, go to our website for the network. Take a look there. We’ve got a lot of information to always keep you updated because as always, your success is ours.

Until I see you next time, be well, my friends.

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Pelvic Floor and Pregnancy – Dr. Krystal Couture

In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

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Hello everyone, and welcome back. I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’m here for another blog. Brought to you by the American Acupuncture Council. If you haven’t popped over to the American Acupuncture Council website, you absolutely should because they sponsor amazing vlogs throughout the month.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

In order to really understand what’s happening with the body through pregnancy, I want to talk about the energetics of pregnancy and conception, as well as talk about a little bit of the spirit of the Po, evolution, hormones during pregnancy, the Yuan Chi, Teeny bit about pathologies during pregnancy bodily changes and then the restoration and repair process of The body that it goes through during that pregnancy experience so in the simplest terms when we’re talking about conception is going to be the addition of Yin, and yang Right?

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Yin is going to serve us as those prenatal qi energies and the postnatal qi energies. So therefore we’re going to have the connection of essence and blood. Yang is going to serve as the minister fire. As we go deeper into conception, the mum is going to provide different things. Then the father is going to provide, right?

And in order for them to provide these in balance and harmony, they have to be balanced and harmonized within each of the individuals prior to conception. This is going to lead to the healthiest form of. pregnancy and for the fetus, right? So we want the mom to have the spleen, the liver and the heart in good communication with each other, and also in the perfect balance, not in excess.

Not in deficiency, and this is so that making, storing, and the governing of blood will be harmonized for the pregnancy and for the fetus. The chong and the ren also need to be in balance, and they need to be open for pregnancy. to occur. The chang is going to be that mover of the blood and the ren is going to provide us with that yin.

So we want to see harmonization there. We also want to see the kidney jing in a state of vitality, right? We need the mom to be vital when she comes into pregnancy in order for her to remain vital throughout the pregnancy and after the pregnancy because that takes so much. energy. I also need her to be vital because she’s going to be providing that energy to the baby as well.

I want the minister fire again to not be in excess and not be in deficiency. We need the perfect amount of fire. We want the postnatal chi and blood to be in harmony. Which of course is determined by so many life factors and how one is choosing to exist within their life along the path of their Tao.

And then finally the spirit of the Po is going to come in. From the dad, we need the liver to be in harmony. We also need that vitality from the kidney Jing and of course the postnatal Qi and blood. All of these in harmony and balance are going to contribute to a better life. Successful and bountiful, abundant pregnancy that serves the fetus to the highest and best.

So let’s talk a little bit about the spirit of the Po here. So the Po, as we know, is the corporeal soul. It is the tangible. It is the spirit of the lungs and it resides within the lungs. It is a physical soul. So it has a yin nature to it. It is going to be transferred from the mom. To the fetus, the PO, as we know, is the soul that comes in with the body at birth and it dies at death.

So it does not extend its spiritual journey. It’s corporeal. Thus, the constitution of the baby is reflective, not only of the kidney energy of the mom and dad, but also the mother’s lung energy, right? Spiritual access. Chapter eight says the corporeal soul is the entering and exiting. of essence. And I really love that quote.

And I really think working with the Po is so helpful in the journey to working with moms in their fertility phases. So let’s look at the Kinney Jing evolution. Okay. So during menstruation versus pregnancy that we’re going to have a different experience here. So during menstruation, we know that the kidney gin, it links to the Tian Gui, right?

The heavenly waters, the minister fire acts upon that. And then we have menstruation, right? During pregnancy, that kidney gin is going to nourish the fetus and it’s going to replenish and recycle. The Tian Gui is going to replenish and recycle to Restore and serve that kidney jing. So we have two different pathways of what’s happening with the kidney jing here.

Now we’re going to have abundant yin, right? We’re going to have an increase in fluids with that tian gui replenishing and nourishing the fetus. We’re also going to have abundant yang because there’s no release of that minister fire. So there’s a significant abundance within the body, within the pregnant body.

Also, we’re going to have the component of the energy that travels up the chong. To the breasts also with the stomach chi as well. That’s going to transform blood to milk on an energetic level So this kidney gene evolution is two different stories two very different stories of what’s happening in the body And I think that’s important for us to understand as well as to be able to share with our clients What’s happening on an energetic level in their body when their monthly bleed?

is no longer. Let’s talk also about hormones during pregnancy. So we’ll see that at the beginning of the pregnancy, HCG is going to spike and then it will drop the rest of our hormones. So progesterone, estrogen, estradiol cortisol, and of course our placental actogen, they’re all going to gradually increase to the birth.

And then they’re going to quickly drop off. This is why there are so many Different emotions, different feelings, different experiences throughout the pregnancy process and after the birth, there is a drastic change in hormones. We’ll also see just at the birth, we’ll also see oxytocin spike.

And then we’ll see oxytocin and prolactin spiking and cycling. So highs and lows. And that is when the fetus will be, the baby will be suckling, right? So there are those increases if the mom is going to be breastfeeding. So there are continuous changes of what is happening through the hormone cycle.

Now, if the mom is breastfeeding, there is a chance that the progesterone and estradiol, and even the cortisol are going to stay low, which is going to lead to more emotions as well, which are important to consider. So now Yuanqi in the fetus. Yuanqi is derived from prenatal Jing from the parents at conception and stored in the kidneys responsible for growth development and maintenance of life.

Now I really like this quote that I found in the Shilin Temple blog which describes kind of Yuanqi and the cellular nature. So cell division requires a fixed liquid base of Yuanqi which allows the cell which compromises the yin or essence of life to divide. Weakness in the yang qi, or yuan qi, or weakness of the yin causes the cells to lose its true identity, its dao, and to create chromosomal changes which cause the fetus not to develop in a way that is consistent with the laws of nature which desire harmony.

So basically what this is saying is that even at The basic, most simplest cellular level, the body, the fetus is seeking harmony. It is seeking homeostasis, and it is seeking that in alignment with the Tao, with the purpose. And there’s so much power in that, there’s so much understanding in that, and there’s so much energy that is required during that phase.

Very briefly, let’s touch on pathologies of pregnancy. The first that we’re going to talk about is going to be a deficiency which could be of blood and yin as well as kidney deficiency. Now this is going to be particularly seen in those who have a tendency toward overwork and thus may have a pre existing kidney deficiency.

Could be kidney yang or kidney yin depending on other factors, right? It’s really important for us to understand our clients that are over workers. If they are coming in with these types of deficiencies that likely, unless they make major lifestyle changes, they aren’t going to change during the pregnancy.

So we want to address that. We want to be aware of that so that they can have a successful fertility into pregnancy journey. Another thing that we’re going to see. is rebellious chi and rebellious chi is, it makes sense, right? Because of the physiological process that’s happening within the abdomen, that there’s going to be this upward rising energy where there’s meant to be a downward rising energy.

Now, this rebellious chi is going to impact the stomach channel as well as the Chiang Mai. And these are particularly related to emotional stress. So while there is that physiological component, emotional stress is going to compound rebellious chi. There’s also, again, with what’s happening in the middle here, that middle jiao can be obstructed and cause some spleen chi deficiency.

And the buildup of phlegm again, sounds obvious during pregnancy, but important for us to be really aware of. This is also going to be something that can create some disharmony between the Ren and the Chong channel, which we want the Ren and the Chong to be strong for fertility and strong throughout the pregnancy and afterwards.

So why are we bringing up pathology in this workshop? Really the key here is because I want you to be aware of the contributing factors. that can impact pregnancy and also that might impact the pelvic floor. So we start to think about kidney deficiency, right? And if this leads to our liver yang rising, or it liver win rising, that kind of thing, or An ultimate a deficiency in that Yuan qi that’s going to be an impact on the pelvic floor because of its connection with the kidneys, right?

And the reproductive system, that rebellious qi, that confusion, proprioceptive confusion of upward versus downward energy is going to be difficult for the pelvic floor. rises and falls as well, right? With contraction and relaxation. And so if there’s proprioceptive congestion or confusion in the energy channels, there’s going to be physiological proprioceptive confusion.

So want to be really aware of these pathologies and to advise our clients that are coming in for fertility in. The manifestation of overwork in the manifestation of over stress, right? And how they can really focus on this fertility time, focus on this pregnancy time to be with themselves and to be nourishing their own bodies and their babies.

Speaking of, let’s talk about the body. I’m really excited for this section. So in ideal circumstances before pregnancy, what we’re going to see is that the internal organs and the pelvic organs of the abdomen all share space. There’s no major distinction or separation between the organs of the pelvis and the organs of the abdomen.

The organs of the pelvis and the organs of the abdomen, they work in harmony with each other, and there’s enough space. So there’s no crowding within the body kingdom on a physiological level and an energetic level. Now again, this is an ideal situation, right? If we have a client that has endometriosis or has inflammatory bowel disease or something like that, we’re going to see something that looks a little different.

But for our purposes today, this is an ideal situation. At six to seven weeks of pregnancy, things start to grow a little bit. The uterus starts its growth process and the uterus actually within the pelvis starts to put some pressure onto the bladder. This is why we can see the need for increased urination, increased frequency of urination and urgency of urination.

early on in a pregnancy. The placenta is also developing in this six to seven week phase. At 10 weeks, things begin to change. The ligaments of the pelvis actually start to relax just a little bit and the pelvic joints loosen. So this is going to be the sacroiliac joints, the pubic joints, and the hip joints.

And this can actually lead to some of that. early on discomfort within the joints at the very beginning of a pregnancy. So it’s important for us to be aware of. Now, of course, we can also posit that as the ligaments are beginning to change, as they’re relaxing just a little, as the joints have more space, guess what?

The pelvic floor is going to be impacted as well because there’s going to be a little bit of a stretch on the pelvic floor already. So the tension within the pelvic floor is already starting to change at 10 weeks. At 12 weeks of pregnancy, things really begin to move, right? So the uterus is now the size of a grapefruit and it fills the pelvic bowl.

The uterus rises during this 12 week phase. It starts to rise into the abdomen because it’s too big to just stay within the pelvis. the pelvic bowl itself with all the other organs that are there, right? The anterior part of the pelvis sits upon the pubic, I’m sorry, the anterior part of the uterus sits upon the pubic symphysis.

So the bladder here, good news, yay, gets a little bit of relief. But the pubic symphysis is now going to be carrying the load, which progresses over time, right? So we can start to see this shift into pubic symphysis pain at around 12 weeks or a little bit later. Now, between 12 and 36 weeks, the pelvis starts to shift anteriorly.

So it’s neutral position is here and it starts to tilt forward, right? So that starts to begin at 12 weeks of pregnancy. Now there’s an automatic implication to the pelvic floor here, right? Because that pelvic tilt is changing the balance and the position of the ligaments, the tendons, and the muscles within the pelvic floor.

At 20 weeks of pregnancy, things begin to get squished. The rectum, the sigmoid colon, and the small intestine get pushed up and back. The ascending and the descending colon aren’t generally affected during this phase. The uterus continues to move up and push on that lower abdominal And at this point in time, abdominal strength and muscle tautness really impacted the position of the uterus being more anterior posterior.

So someone that has very tight, either fascia or musculature, or has strong abdominal contraction, the. Uterus is going to sit further back, whereas if the abdomen is weak or it’s slack for whatever reason, then the abdomen is going to push forward a bit more. Of course, there is that play with the abdominal muscles and the pelvic floor as well.

They are so deeply connected. I can’t tell you the number of times, not with pregnant clients, but in general with clients postpartum. Or clients unrelated to pregnancy that I work with the abdominal muscles and we can make a shift in the pelvic floor. Such a cool experience. But moving on without getting a ton of tangent at 21, 28 weeks of pregnancy, things really.

get compressed and the weight distribution actually starts to shift at this point. So uterus expands into the mid abdomen. So it keeps expanding upward and it’s pressing now against the stomach. The load is increased upon the pelvic floor and the posture shifts posteriorly. to carry that load.

So the body literally is shifting back into the heels. Now at this point you may actually have clients that are complaining about posterior fascial chain pain. They’re also maybe talking about pelvic floor pain at this point as well because the pelvic floor is really holding a lot of the load here.

At 36 weeks, things really change. The uterus expands to fill the abdomen. It generally meets up to the xiphoid process and there’s pressure upon the diaphragm. That increased load on the aorta, the heart, and the lungs starts to show up at this point. And the abdominal muscles are really supporting the weight.

They’re working really hard to support the weight of the fetus. The vagina. and urethra at this point start to elongate. And then the perineum actually is stretched and enlarged and it begins to protrude outward. So once again, if we’re talking about the perineum, that’s the space between the external anal sphincter and the opening to the vagina in females.

Now, As that starts to expand, we can obviously make the correlation that the pelvic floor muscles are going to be stretched during this time. They’re going to be stretched to uncomfortable limits. At 40 weeks of pregnancy, the body is preparing for birth, and the head of the fetus lowers into that pelvic bowl.

The bladder, again, is compressed, and the colon is compressed. So this leads to all sorts of dysfunction within the excretory phases. If you’ve been pregnant, you know this. If you’ve been married to someone who’s pregnant, you know this. If you work in pregnancy, You know this, right? The round ligament, the utosacral ligament and the broad ligament are stretched.

So now these deep ligaments of the pelvis are beginning to stretch. Ligaments don’t have the same recoil that muscles do or tendons because they don’t have as good of blood flow. So this is important for us to be aware of because this is also going to contribute to what’s happening in the pelvis and the pelvic floor during the recovery process.

Now, postpartum, the body is going to be seeking recovery. The body, generally speaking, is going to be fatigued. It has just worked really hard for ten moons, right? In order to grow. a baby. So it’s going to be fatigued. It is also going to be stretched. The abdomen is going to be stretched. The ligaments are going to be stretched of the pelvis.

The pelvic floor muscles are going to be stretched. The back may actually be tighter from that weight distribution and that anterior pelvic tilt. The uterus, the vagina, the perineum, and the pelvic floor are going to be expanded, stretched, and potentially weakened, right? If we think about it, if a muscle is at its maximum stretch, it’s pretty hard from its maximum stretch to get contraction, right?

Whereas if it’s at a comfortable place in elasticity, getting contraction and relaxation is a lot easier. So there’s going to be some proprioceptive and kinesthetic changes that are occurring as well. Ligaments in the joints are going to be unstable initially. Everything is open and the organs are in a new alignment, which can lead to a lot of body and energy confusion and hormones.

Guess what? They’re all over the place. They are changing frequently and they’re changing differently in different people. So there are a lot of things going on with that body postpartum. In order to restore and repair postpartum, the organs have to return to alignment and function. The uterus size and position all has to return to its, pre pregnancy stage.

The perineum needs to heal. There’s going to be a ligamentous and joint recoil and repositioning that occurs. There’s going to be the fascia, the diaphragms, and the posture are all going to Balance or not balance. If the proper work and attention isn’t done or if the body is in severe depletion beforehand, the muscles of the abdomen, the back and the pelvic floor are all going to change.

The blood and the fluid will level out. And the energy and the meridian flow also hopefully will realign. And then there’s the emotional harmony. All this to say, and we have a whole talk coming up on postpartum, which is really exciting. But all of this to say, the body is going to try to do all of these things on its own.

Why? Because it is always seeking homeostasis. The body wants balance with the body. The Dow, the body wants to be in balance with your purpose here on earth. So it wants to do these things. Now as acupuncturists, we can help clients to intervene in this process and to facilitate the healing in all of these, in all of these phases, right?

There’s more than nine, but I just listed nine out so we can really do an amazing job to support our clients with the. Restoration, the recoil, and the return to their pre pregnancy state. Now, if you’ve been with me and the American Acupuncture Council before, you know that I have previously recorded a pelvic floor intro, a chat on menstruation in the pelvic floor, a chat on fertility in the pelvic floor, and this, of course, is our pregnancy and the pelvic floor chat.

We’ll also be doing a postpartum chat. And a menopause in the pelvic floor chat. So I can’t wait for more time with you. And I really hope you enjoyed our time today. Once again, I want to thank the American acupuncture council for sharing this space and sharing this vlog with acupuncturists around the globe so that we can share these teeny tiny little nuggets of wisdom that hopefully impact you, your practice and your clients.

In a positive way. Here’s some references. Once again, I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’ve thoroughly enjoyed my time with you today.

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Treating TMJ with a Multifaceted Approach Part 1

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Hi, my name is Michelle Gellis. I’m an acupuncture physician and I teach cosmetic and neuromuscular facial acupuncture classes internationally. I just completed my first book. It is called Treating the Face and it is a comprehensive guide. It’s a hardcover book. It’s a comprehensive guide to treating the face, both for cosmetic and neuromuscular Conditions.

I’m currently on the faculty at Yosan University on the doctoral faculty. And prior to that, I worked at, I was on faculty at the Maryland University of integrative health from 2003 until 2021.

Sorry, I having trouble getting going to the next slide. There we go. So these are the different chapters in my. book and it’s a full color book and some of the images that will be in today’s presentation are from my book. So today we’re going to talk about this is part one of a two part lecture on treating TMJ.

And today I’m going to go over the definition, the etiology, and using facial motor points to treat TMJ. And then in part two, I will go over using scalp acupuncture and submuscular needling to treat TMJ. So what is TMJ? TMJ is short for temporomandibular joint pain. It is also kind of part of TMD is another way of referring to it for temporomandibular disorders, and these are any issues that arise from any jaw pain, jaw problems that come from the muscles surrounding the jaw and can cause problems opening and closing the jaw.

And the temporomandibular joint, or TMJ. for short, is the actual hinge joint that connects the mandible to the temporal bone of the skull. So we’re going to go through, as I mentioned, the definition, and then we’re going to talk about motor points. is the temporal bone right here, and this is the mandible.

And here is the joint that we were discussing. And here’s a blow up of that. So you can see where this condyle goes into the temporal bone and there’s a disc here and there’s various nerves that are attached to it. What can happen through grinding the teeth? or injury or stress, which can cause tension.

People can develop temporomandibular joint pain or TMJ for short.

TMJ can manifest as many different things, not just in the jaw area. People can have pain behind their eyes, different issues with their eyes. They can have limited ability to open their mouth, clenching, grinding. They can have sore teeth. They can get headaches because of the location of the temporal muscle.

They can have issues with their ears, vertigo, dizziness, ear pain neck pain, and of course pain in the jaw and clicking and popping of the jaw. So as acupuncturists, we can do some local treatments with acupuncture and treat the channels that are involved. And so some local points might be stomach five, stomach six, you might treat gallbladder four, SI 19, Sangio 17, Tai Yang.

And then using some distal points, like large intestine 4, which is a command point for the face and jaw. Sand jaw 5, gallbladder 41, which are the master couple point of the young way my. And if they have constrained liver qi and they’re grinding their teeth, you could do liver three and liver four and you can combine some other points such as gallbladder 34, which can help to supplement liver three.

But one of the things that I have found in my practice to be really beneficial when treating TMJ are facial motor points. Facial motor, what facial motor points are, they are the most elect, they’re located in the muscle. They’re the most electrically excitable part of the muscle where the motor nerve bundle is attached.

And specifically, it’s the skin region where the muscle is most accessible to electrical activity. excitement at the lowest intensity. So you can actually measure them. Motor points are not trigger points, trigger points, or tender points, or ashi points, that when you press on them the person is tender.

And fortunately for us, when we’re looking at the face, many motor points are also acupuncture points. When you’re trying to figure out what motor point to use when treating the face, you have to determine what muscles are affected, and then you would look at the motor point on the face. That muscle.

When needling motor points on the face, it’s a good idea to use some ornicogel and a very thin needle. You don’t want to be using a really heavy gauge needle because stimulating the needle could possibly cause some bruising.

Here is an image I took from an old this is an old medical text and they actually outlined all the different motor points on the face and neck. This is from the late 1800s, which I thought was very interesting. Motor points have been used for quite some time. Here is a picture of a nerve and going into the muscles.

So we have the sensory nerve and then we have the motor nerve and the motor point. is, as I mentioned, the most electrically excitable part of that muscle.

There are many motor points on the face. We’re not going to talk about all of them. We’ll just be focusing on a couple, because when we’re thinking about TMJ, the muscles that are involved are going to be the masseter. and the temporalis.

So here’s the temporalis muscle as you can see, and here is the acupuncture point gallbladder A. The motor point for the temporalis is just anterior, it’s one cun anterior to gallbladder A, and you would use a perpendicular insertion. The goal is to go into the muscle, but not through the muscle. The temporalis works with the massetere.

Here’s the massetere to move the mandible up and down and by when a person has TMJ, the temporalis can get very tight and by releasing this motor point, it can relax the entire side of the head and face. and jaw.

Another muscle with motor points that we would use for TMJ is the masseter and here is an image from my book of the masseter and then the it has two motor points and one of them is small intestine, six. And the other one is just below stomach seven, it’s just inferior to stomach seven, and it is level with the earlobe, and you would needle this about a half to one soon deep, because you’re going through the flesh and the fatty area of the face right here.

And this is really wonderful for jaw pain as well. Now this is demonstration of what can happen when you needle a motor point properly. This is not the masseteer or the temporalis, but it was a good display of what happens when you needle a motor point. So, I wanted to show this. Where’s my Ah, there we go.

So this person had had Bell’s palsy and they had a lot of trouble pursing their lips and so this is actually muscle on the chin and you can see when I stimulate the needle, see if I can get that to go again, when I stimulate the needle This is in the mentalis. When I stimulate the needle, how it really jumps, it’s already moving on its own.

And then once I stimulate it, it really causes the muscle to jump.

So next time we are going to talk about other ways of treating TMJ using scalp acupuncture and submuscular needling. And I want to thank the American Acupuncture Council for this opportunity. You can go to facialacupunctureclasses. com and let’s see, I have a slide here. Sorry. You can go to facialacupunctureclasses.

com and you can learn more about some of the classes. That I teach. Thank you so much.

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Take a Break Content Creation: Using Instagram – Michelle Grasek

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Hi there, my name is Michelle Grasek. I’m an acupuncturist and a marketing strategist and the host of the Acupuncture Marketing And today we’ll be talking about a new way to think about using Instagram that does not require any new content creation. It is specifically using Instagram for business to business networking so that you can build real connections with other local business owners and expand your Visibility in your community.

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And before we get started today, I’d like to thank the American Acupuncture Council for the opportunity to be here with you. All right, let’s get into the slides. Using Instagram for business to business networking. Today we are going to briefly cover why would we do this, why use this approach, why does it work, and then two specific strategies for building these relationships with other local business owners and collaborating with them.

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So why would we take this approach to Instagram? I don’t know about you, but most of the people I know are generally a little burnt out by content creation for social media. As you know, content creation takes time, it takes energy and creativity. And over and over again, that kind of feels like a hamster wheel.

Yes. So if you are feeling kind of worn out by content creation, this is a great strategy. And you have probably noticed in the past year or year and a half that your engagement on your account has gone down. I know that for my own business, Instagram accounts, and for my marketing clients and students, they are reporting that their likes on their posts and their reels has gone way down and so have their views, right?

They are being exposed to way fewer new accounts and even the people who follow them on Instagram are not seeing their posts that often. Okay, so big picture, if you’re experiencing this, you are not alone. It is pretty much across the board. For example, people who were previously getting 50 to 60 likes per reel or post are now kind of struggling to get 5 to 15 likes.

So again, if this is you, you are in good company, but it can be very frustrating to spend time creating content that you feel like No one gets to see, right? Is it effective? So if you need a break from all of that, then this strategy can be a really nice choice. Business to business networking on Instagram is is both a refreshing approach to using Instagram and a refreshing approach to networking.

So why is that? So first of all, it’s a nice approach to Instagram because you can either take a break from content creation or you can scale back the volume of content that you are creating. I know that some of my marketing clients are concerned about stopping content creation altogether for Instagram or any social platform because they’re worried about getting dinged by the algorithm if they don’t create content.

publish new content. So I understand that. If that’s how you feel, it’s all good. You could think about maybe using this strategy and cutting your content creation in half. So if you usually produce two reels a week on Instagram, maybe just do one and then use the time that you would have used to create that other reel for this strategy, for networking, for building connections and collaborations.

So that’s one option. And, or, forgive me. So the other reason that this is a nice approach to using Instagram is that it does leverage all of the content that you’ve created for Instagram in the past. So you’ve probably been creating Posts and Reels for years on your account and when someone lands on your account homepage, they get a really good idea of what your business is about, who you serve, you know, what your values and priorities are, how you can help them just by scrolling through all of your recent posts and reels.

Right? They can get a really good idea of what you’re all about. And so this is really helpful for business to business networking because you are going to engage with other business owners and ask them to collaborate, and they can simply pop over to your account homepage and look through the content you’ve created, and that will give them a great idea of whether you are a good fit to collaborate with them.

Do you match their own values, ideals, and goals, etc. Right? Do they think you’d be good? Partners in this endeavor, whatever it is you’re asking them for, whether it’s an acu yoga collaboration or something totally different. Okay. And this is also a really nice way to think about networking because it’s much lower pressure than traditional networking meetings.

I do find that many, many acupuncturists Of course, not all, but many are introverts, myself included, many of my marketing clients and students are introverts. And for, for the most part, people tend to not like traditional networking meetings where you go and you don’t know anyone and you sort of stand around awkwardly with a drink waiting for someone to talk to you, or you have to insert yourself into a conversation and then introduce yourself.

So, Doing this kind of networking obviously doesn’t require any of that. It simply allows you to build relationships that are genuine at your own pace. So, this is a way to connect with people, potentially in your pajamas from your home. And it’s just much more comfortable for many people, but it’s still equally effective.

And I also like to point out that this approach to networking can be very specific. You get to choose the best business owners or influencers that you’re interested in working with because you’ve, you’ve vetted them and you think a collaboration would be beneficial to both of you. And you can spend your time and energy building a connection with them on Instagram, as opposed to when you go to a traditional networking meeting, you might meet a dozen new people and it could be very varied, right?

Like maybe an insurance salesperson or a real estate agent. And. It’s not that you would never collaborate with those people, but you sort of have to sift through the people that you think would be open to a collaboration and would be a good fit if you’re doing traditional networking, whereas This type of networking is very specific and I think everyone is very busy and if you can fit Instagram networking into your schedule whenever you have a free moment and have it build into Meaningful relationships with a few people instead of superficial relationships with a dozen.

I think most people really appreciate that. So what are these strategies that I keep talking about? It’s actually very simple. Your goal is to connect with real life local business owners. Who you think have an audience who would be a good fit to become your patients. And when I say business owners, I’m also including influencers in this.

It’s sort of interchangeable in some ways. Like some local business owners, they actually have a brick and mortar business. Others are influencers. They might sell something, but really the The main point here is they have a following that you think would be a great fit to eventually become your patients.

They, their following is your target market. Okay. And your goals here are once you’ve made a connection with them to pitch them an idea to collaborate on an event together, or it doesn’t have to be an in person event, whatever ideas you have that are mutually beneficial for the both of you. Or, You can ask someone to come into your office for treatment and do a trade for the treatment and social media exposure.

Okay, so we’ll go more into these strategies, but big picture, this is our goal. And honestly, it works very well. My marketing clients and myself for my practice, we have All countless examples of relationships that we have built with small business owners locally who we never would have met or bumped into in real life, but connected through Instagram and now have these long term, very supportive, collaborative business partnerships or relationships.

Okay, so that’s, that’s what we’re going for here. So I recommend if you don’t have anyone in mind already, and you may, someone that you follow on Instagram, you might say, gosh, I’d love to work with so and so at that yoga studio. We could host this event. It would be fabulous. That’s a great place to start.

Just think about who are the business owners that you admire. Someone where you can genuinely say, I love what you’re doing in the community and I’d love to work together. I think that we have you know, a shared vision or shared goals for our communities and I’d love to work together. If you can say that for real, then you are on the right track and this is probably a good person to try to connect with.

And of course, you also want to make sure that you are choosing people who are local because you want people who can actually come to your clinic, right? So within maybe 45 minutes of your clinic, it’s not that useful to connect with influencers or business owners who are pretty far away because you like, what are the chances that someone who’s five hours away is actually going to come see you for treatment, right?

So that’s not what we’re interested in. We want these people to have followers who are local and who are in your target market. They’d be a great fit to become your patients. Okay. So just thinking about that when you’re trying to decide who are four or five people I’d like to connect with on Instagram.

to build a collaboration. And let’s talk a little bit about influencers. I think we get a bad taste in our mouth when I talk about influencers. I’m talking about nano and micro influencers. So not people with like a million followers. Nano is up to 10, 000 followers. And micro is 10, 000 If you can believe that, they’re still considered micro if they only have 100, 000 followers.

But the idea here is that smaller local accounts, as long as they have an audience who really listens to them, takes their advice, gets good engagement on their account. That’s what you’re looking for, right? And they also are people who would be a great fit to become your patients. So if someone has 6, 000 followers, that’s great, right?

They don’t, they don’t have to have 100, 000. In fact, smaller influencers are more likely to work with you because they have that local connection. And we’ll talk about this in a moment, but I recommend doing a trade for the influencers. Sharing you and your business on their account. Okay. Instead of paying them money to do that.

And again, that’s up to you, but I think that smaller influencers are more likely to accept the gift of a treatment for a trade, than instead of being paid cash, as opposed to like larger influencers are looking for quote brand deals on something much more formal and more money. Okay, so again, you’re just thinking about who would you be proud to work with, whose account would you be proud to be represented on, and who has an audience that is a good fit as your target market.

So some ideas. Who might these people be? Okay, yoga studios are a great fit. I have done some beautiful collaborations with the owner of a low waste specialty shop near me. She only sells things that are plastic free, for example, but she is really into alternative medicine. She’s very supportive of natural health approaches.

So the more you get to know people on Instagram, the Better awareness you have of who’s a great fit to work with and collaborate with, even if they’re not health care providers, right? So don’t limit yourself to just health care providers. Photographers can be fabulous. Photography tends to do really well on Instagram, and so their followers They tend to have a lot of followers and be very engaged.

Lash specialists, artists of all kinds. At my office, we have a wonderful collaboration with a collage artist and some watercolor artists. And then of course you could think about chiropractors, therapists physical therapists, nutritionists, hair salons and estheticians, makeup artists. Those are great choices.

Med spas, they tend to do very well on Instagram. They get a lot of engagement. So try to think outside the box. Again, it’s just, who would you be proud to be associated with? Like who you’d be pleased to be featured on their account and who’s got your target market. So how do you do this? This outreach thing, it’s actually very simple.

There’s two approaches you can take and both, both work well. It sort of depends on your. Maybe your personality and your comfort level with each. So the one approach is what I consider dating before proposing to someone. So I often think of marketing this way that you give your audience the opportunity to get to know you before you say, do you want to buy my stuff?

Right? So in this case, it would look like You know, you would pick a business owner that you’d love to collaborate with, you would follow their account, you would regularly check in on their account for new posts or reels or stories, and you would like all of them and try to comment. So whenever they publish a new reel, for example, you’re liking and you’re commenting.

And I would say try to Ask questions of the business owner in your comments so that you can engage with them right away and they will start noticing if you’re doing this repeatedly. So over time you’ll become pretty familiar to them as someone who enjoys their work and engages with their account and when you’re ready, when you feel comfortable basically, you can shoot them a direct message or private message and then you can more formally introduce yourself and pitch your idea for collaboration like, Hey, my name is Michelle.

I run Ageless Acupuncture in Seneca Falls. I absolutely love what you’re doing and I was wondering if you’d be interested in collaborating. I have a couple ideas. Let me know what you think. I’m so excited to hear from you. Right? So just cheerful, positive. They’re already familiar with you. By and large, people are going to say yes.

And then you can have a conversation and see what sort of collaboration might work well for you. And we’ll talk about collaboration suggestions in just a moment. There’s a million different things you can do. It’s really, the sky’s the limit. It’s up to your creativity. Creativity with this other person.

Okay. And then the other option is just to go right in to their direct messages and introduce yourself and share your pitch. And I have seen this work as well. You know, if your idea is strong enough and beneficial enough for the other business owner, they’re probably going to be interested in answer you because Because it’s interesting, right?

Because they are willing to have a conversation about it. You know, especially if you go about it in a really nice way, where you emphasize how much you, you do enjoy their account and, and the work that they’re doing in the community. And maybe give them some extra reasons why you think working together would, would go well and benefit both of your audiences if you are just diving in with that DM and they don’t know you that well.

But again, I think either of these methods can be very successful. It’s just up to you and your personal preference, how you’d like to connect with them. Regardless of how you go about this, when you are making your pitch for collaborating, make sure you focus your collaboration request on the benefit to the business and their clients or patients and the community that you mutually serve because you’re very likely to have some overlap between the people that you serve, but just angle your collaboration idea from the perspective of all the ways it would be great for them, okay?

For example, you could mention that if you did acu yoga, you would be thrilled to share the class on your, all of your social media and in your email newsletter, so that you’d be exposing them in their business to all of your audience. Naturally, they are going to do the same for you, right? But when you are approaching them, you want to emphasize this aspect of why would this be so great for your business for this reason, or this is one reason.

So really quickly, some collaboration ideas. There’s a lot here. You can take a screenshot if you’d like. Accu Yoga is very, very common. If you wanna collaborate with a yoga studio, you could. Teach a class together, maybe at the community center. You could host a class where they teach something at your office, so you’re giving them a platform to share their expertise with your audience, and they could do the same for you.

You could host a book club together, maybe wellness books, whatever it is that fits for both of your audiences. You could host a pop up event for them or vice versa. I have seen people host weekend wellness retreats because of collaborations that started on Instagram. I mean, some of these ideas make the business owners thousands of dollars because they really get creative and passionate about it and build it out into something so much bigger than they initially imagined.

You could host a fundraiser together for a charity that you mutually support. Themed wellness nights, Valentine’s Day is coming up. It’s a really good opportunity for a themed wellness night. You could do giveaways where you collaborate across both of your Instagram accounts. You could host a networking event together for other wellness people in your area.

The list goes on.

Okay, thank you so much for being here with me today. I hope that you find this Kind of invigorating. Hopefully it is a really refreshing way to look at Instagram and networking. If you have any questions about this, these strategies or marketing in general, you’re always welcome to email me michelle or michelleGrasek.

com. I hope you’ll listen to the podcast, Acupuncture Marketing School, and check out my website for free marketing resources for acupuncturists. Before I go, one last to the American Acupuncture Council. I’m very grateful to be here with all of you today. Thank you.

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Are You Ready for 2025? Sam Collins

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Happy New Year and greetings to my friends and colleagues. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and more notably, you and the profession. I’m here to help you to make sure that you get information that keeps you up to date and moving and there’s nothing better to get knowing what’s going on than let’s get ready for 2025.

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So let’s go to the slides. Let’s talk about are you ready? for 2025? Are you really setting yourself up? Realize this is that first week, so everyone’s back in. Let’s get things ready. Let’s be proactive, not reactive. So the first thing I will tell you to do, you want to start thinking if you’re doing any insurance, but for that matter, even cash, we’ll get into it.

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Are you prepared? For insurance, I would say prepare for understanding What’s going on for plans in 2025? Is anything changing? It’s time to go back through to see what’s new for certain plans. Now, keep in mind, if I have one person that works for a company and has insurance A, another patient that comes in from the same company with the same insurance, I don’t have to go through all of that if I do one thorough way of going through that policy on one person, so long as everyone has the same policy.

So the first thing I want to look at is, What’s going on with deductibles? Has there been any changes for 2025? Did it increase, decrease, stay the same? By example, though acupuncturists don’t directly bill Medicare, you’re involved now. The Medicare rates, of course, did make a nice increase. We’ll get into that.

But the Medicare deductible did go up 17 to 257, which means if Medicare went up, might other plans. Yeah, that’s a hit and miss, but check. One thing I’ll point out though, that a lot of times acupuncturists are not familiar with, however, is that deductibles may roll over, meaning that they will not have a new deductible at first of the year if that person saw a doctor in the last quarter, and what this means is, let’s say by example, you don’t go to the doctor at all.

You’re a patient, and in December you go to the doctor, you have a $1,000 deductible, you have to go and you meet that deductible. Then January 1st sits and you’re like, oh my God. I gotta pay the deductible again? I just they don’t punish someone in that way. Most plans will have some type of rollover for a person who’s seen the doctor within the last part of the year.

So it’s worth checking. Often that may not be the case, but it’s worth looking into. So I would check to make sure. Most importantly, We want to know deductible so we can make patients aware of what they’re going to pay. And keep in mind, we also want to check on not just deductible, but what’s happened with any coverage.

Has there been any changes to the benefits? Is the acupuncture benefits better, worse, or the same? By example, a lot of people have said, Sam, I heard that the Medicare Advantage Plans were getting rid of acupuncture. They were not. So long as the person has the standard one that has what we call gosh, I gotta think of the term, but it’s where you’re going to have just a acupuncture benefits that are there all the time.

Realize all plans under Medicare have the regular benefits, meaning, MD supervision, but for those that have routine acupuncture, it will cover for pain management. Look to see if any of that’s changed. Many of them may or may not have it, so always check. Don’t assume. Regular Medicare did not update.

You will still need for regular Medicare Part B medical supervision. Do check though, because this is something that’s occurring with some of these Medicare Advantage plans and others, is the requirements for pre authorization. Many of the Medicare Advantage plans continue to have it, but the ones under United, at least some of the plans, and others under Humana, will require pre authorization, which means they all allow you to do the first visit, but then you have to request more after that.

Not that it’s that hard, it’s all online, but it’s just something to know. You don’t want to bill out assuming it’s being paid and they later say, oh it requires pre authorization, because often they will not do a retro authorization. So do check to make sure what are the coverages, what are the changes, are the number of visits the same.

Are they combined with anything? Is there any limits? And this is something to keep in mind. The limits to acupuncture benefits under insurance are limited to what are they covering under the diagnosis they allow. By example, Cigna has probably a 500 code list of things they cover. Aetna has a list that’s about 25.

So you can see clearly one more that’s going to have a little bit more or possibly more. So know what those plans cover. Don’t assume. Some plans will cover fertility. You want to check to make sure it does it. And here’s my point. Get as much information about beforehand so we can make sure that we understand what’s going on with what are we going to bill and how we’re going to be paid.

Because one thing to look at is what’s going on for fee schedules for this year. And I want to talk about just your common CPT codes. I don’t care about things you don’t do. Most acupuncturists, of course, are going to do exam codes, E& M codes. Acupuncture, of course. And then maybe a handful of therapies.

What I care about are those codes. Here’s some really good news. The relative values For the first set of acupuncture, both manual and electrical have increased substantially. For most of you, if you’re billing the VA, this literally means you’re getting about a 20 percent increase in that allowed rate.

That’s pretty significant, which means that may roll over into other plans because plans that use Medicare, which include VA, Personal Injury Work Comp, et cetera, will be increasing. Now, the downside to this, of course, It’s not going to affect your ASH. It’s not going to affect your Optums. Now, if you’re part of ASH, certainly if you’ve been in a while and you’re a tier six, I will be looking for, have I done a protocol to ask for a raise?

That’s something to be thinking of, but do take a look and think of, wait a minute, how much it’s increased. Now be careful. Relative values tell you what to charge from one code compared to the other. So I want everyone to start a little bit differently. Literally, you’re going to see a large increase. in the first set.

If you want to get more details of that, I’m going to tell you. Come to our seminars with the American Acupuncture Council right at the end of the month. Keep you updated there. If you’re a network member with me, just get in contact with me. I’ll get you set up. But really, this is a significant difference for you, particularly when it comes to things that are related.

VA, of course, but everything else related, which is going to be and so forth, which means prepared to understand. W for this year? What type do we have in place? Make are always aware of your think of what’s the numbe ask beyond if you can hel

Make sure you get something new for the year. Now, if someone’s on an ongoing care plan, they started in December, I’m not concerned, but someone coming in new this year, always have them sign a new and updated financial agreement so there’s no surprise. That’s why we have the No Surprise Act. Make sure they’re aware of what their costs are going to be for what services are covered.

And maybe some services that are non covered. By example, on some ASH plans, they don’t cover massage, which the patient can be charged for. Therefore, we got to make sure they’re aware of it. The bottom line is, just like for you, if you go someplace, you want to know the cost, make sure your patients are aware of their cost as well.

Which means, are you doing anything financially with How do you set up properly for a cash discount? Outside of California and Minnesota you got to be very careful. They allow some big differences but for most states you can make a 5 to 15 percent so if your rates raise up that should be the same thing for cash.

But what about prepays? I do think prepays should be something that every office offers. I’m not going to say it’s absolute that every patient’s going to want one, but I’m going to tell you some patients are. And it’s a good way of creating another revenue stream because people can see it as affordable.

And remember, prepays allow you to discount more than a 5 to 15%. Now what about your assignment of benefits? Remember, patients need to sign a new assignment in the new year. They want one up to date. If you’ve not seen someone in a long time even, Make sure they’re signing a new assignment. What is the assignment?

That just tells the insurance company, pay the doctor. This is something many of you may have gotten letters asking you about that for the VA. Not a big deal. Should always be on file. I would just make it at first of the year. As patients come in, they sign a new assignment January 1. Which means we’re always offering compliance.

Our compliance when it comes to HIPAA. What have you looked there for a while? Have you seen, is my privacy notice up to date? Does it have everything that I do? Which by example, Almost everything is open. What if you say, Hey, I want to make phone calls to remind you about appointments. There’s nothing wrong with that, but in order to do because that may not be private, the patient has to give permission that, oh yes, you can call and leave a message, because that line may or may not be private.

So keep that in mind that if I’ve not done anything to update, have I looked at it? Do I have all the things in place? Do I have business associate agreements? Who am I working with, whether it’s a billing service or an electronic record company? Are they all HIPAA compliant? They should be, but make sure you’ve got things in place protecting ourselves.

Now, what about your office policies? Things that you do in the office. There’s nothing wrong with updating those. And I would say two things to look at. Do you have a no show policy? Some offices like to have those. If a person doesn’t show up, do they get charged? Outside of the VA, you may do so do keep in mind, if you have a no show fee, make sure the patients are made aware beforehand.

What about credit cards? There’s nothing wrong with obviously taking credit cards, debit cards, but can you charge extra? You can, but let’s be careful. It’s not a percentage. You could have a fee that says, if you choose to use a credit card, there’s an additional 1, 2, 5 transaction fee, depending on the amount.

Now, and what I mean by that is, you’re going to charge 5. If they’re only charging 15, that seems a little steep, but what I’m getting to is having a fee. What it has to be a separate from the charges. You can’t say the more you charge, the more of the fee, but there could just be an allowed rate.

That’s allowed so long as patients are told beforehand. Make sure, of course, too, you have consents on file. If you’ve not seen a patient in a while, if you’re seeing them from, an ongoing plan from, November, December to now, I think we’re okay, but if they’re coming in with a new care plan, they need a new consent.

Okay? Make sure also that you have the difference between covered versus non covered. Okay? The patients know what is covered, but what is not covered, I want to make sure they understand that’s going to be out of pocket. They’re going to understand that. I want to make sure if we’re doing cash or prepay, the compliance is we have things on file so that no patient comes back and says, I’m upset because I don’t feel it was fair.

Now you may think I never do insurance. I’m not worried about that. Realize. You can get complaints and other things from the board based on this if a patient makes a complaint. Put things in order. Have them to make sure all the agreements are there. And do remember, it’s always documentation, whether it’s going to be financial agreements or what you’ve done for treatment.

And again, I don’t care cash or insurance. If it is not written down, it didn’t happen. So make sure the documentation has what’s going on. A quick review of what you done. You know what a SOAP note is? The S. A review of the chief complaint. and how the patient is changing as a result of care. Is it better or worse?

In other words, it’s what they’re telling me, subjective. The objective is, what did you find? The tongue was coated. The pulse was wiry. There’s muscle spasm, loss of range of motion. And then your assessment is nothing more than your diagnosis. And then from there, your treatment. So for acupuncture, and this is the area we run into the most problems when we deal with audits.

Remember, if you have insurance through the American Acupuncture Council, you have audit protection. So if you’re audited, they’ll help defend you, but it’s hard to defend because if you don’t document what you’ve done for acupuncture, please make sure you’re documenting the time you spend face to face with the patient, as well as the points of each set.

And remember that 15 minute, or if you will, 8 minute rule that follows. If you’re doing therapies are fine. Just make sure that the therapies are documented properly. What am I doing? Where am I doing it? You can’t just check off if I did infrared heat. But tell me, oh, I did infrared heat to the lumbar spine for 15 minutes.

Again, not very complicated, if you will, but document it in a way that it can be seen when what was done. And again, if it’s timed, make sure time is there. When you’re doing an exam or E& M code, are you making sure that if you’re billing a 99203 or a 202, is that clearly the value? A 202 would mean that you spend at least 15 minutes, a 203, 30, or at least one complaint or multiple complaints with strain and sprain.

Make sure that if you’re billing a code, know why. If you’ve never attended a seminar with me, I’m going to encourage you to go, what is the requirements for E& M? I think a lot of times people really misunderstand that. And I’m going to emphasize time. Acupuncturists do spend a lot of time. Document it.

There’s a value to you. That’s getting you prepared for 2025. Document what you’ve done and ultimately the patient getting better. Your practice thrives off of people understanding and having access to you. The understanding Is this going to help? Then they come in and go, wow, that did. There’s a value to that.

Make sure people understand that. For me, the biggest difficulty for acupuncturists is getting yourself out there. Being prepared for 2025 would be, if I have back pain and I’m looking for an acupuncturist, how am I going to find you? Have you set up a network of people that refer? Does your website do it?

Does the signage in front of your office when I pass by, does it let me know what’s going on? Practices thrive based on, of course, patience. And we thrive based on you. We’re here to be your resource. The American Acupuncture Council, of course, more than the malpractice side, I deal with the network side.

We’re here to help you. One on one, a resource. By example, are you aware of what’s happened with the fee schedules? I’ve given you a little bit of that. What about new codes for phone calls and telemedicine. That’s changing for this year as well. It’s more than what we could do in this short time, but I just want to make you aware, be proactive, not reactive.

I look forward to all your success. I hope to see you all at a future seminar. Until then, my friends take care.

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Microneedling for Acne and Acne Scars – Michelle Gellis

So why microneedling for acne? Microneedling is something that is historically been used for cosmetic concerns and when you’re thinking about acne and acne scars microneedling, the only thing that it’s been FDA approved for is for treating acne scars.

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My name’s Michelle Gellis, and I am an acupuncture physician. Hi, my name’s I specialize in facial and cosmetic acupuncture, and today I am going to be doing a presentation, a short presentation, which is part of a longer class that I teach on microneedling for acne and acne scars. So you can go to the first slide.

A portion of this webinar is taken from my book. Let’s see if I can get in the middle. It’s called, thank you. It’s called Treating the Face, and it is a comprehensive guide on treating the face for health professionals. Everything from cosmetic and neuromuscular acupuncture to facial cupping and gua sha.

And there is a chapter on microneedling. So many of the images today are from that. And this is just some photos from the inside of the book. So why microneedling for acne? Microneedling is something that is historically been used for cosmetic concerns and when you’re thinking about acne and acne scars microneedling, the only thing that it’s been FDA approved for is for treating acne scars.

And I’m going to explain that in a moment, but it can also help with acne itself. So what are some of the benefits for microneedling for acne and acne scars? So microneedling can help with the scar itself, it can help with the discoloration, and it can also help with the skin texture. Microneedling will break down the scar tissue.

for the acne scars and it encourages healthy skin regeneration and it helps with the hyperpigmentation, which is a darkening of the skin that can happen when you have had acne. And overall, it will improve the skin tone and the texture making the scars less noticeable. A little bit about acne and there’s different types of acne.

So here is a normal sebaceous gland and hair follicle. And what can happen is the pore of the follicle gets infected with bacteria, and if the skin is healed over it, then you have a white head. If it’s open and oxygen gets to the bacteria, then it becomes a black head. If it gets infected, then you can get this redness around the white head, and If it is inflamed and infected, then you can get a large area of redness, and this is called pustule.

There are also different types of acne scars and boxcar scars. Scars are more of a square shape, ice pick scars are round and deep, keloid scars are raised, and rolling scars are when you have scars that run into one another. What microneedling does is it controls So the little injuries that are, cause when you do microneedling, it stimulates collagen production.

stimulates the skin’s wound healing responses, activating these fibroblasts, and these fibroblasts produce collagen, elastin, and to repair the skin. Microneedling. Also creates little microchannels in the skin, so whatever products you may be using get better absorbed. Here is a picture of a cross section of skin.

Here is the and this is just the epidermis, so the outer layer of the skin. These are all the dead cells on the top. And this is called the stratum corneum, and down here at the bottom, this is the stratum basal, and these are where all the new skin cells are produced. And so when you microneedle, you are both helping the stratum corneum to be exfoliated and you’re reaching down past the keratinocytes down into the stratum basal where the new fibroblast cells create healthy collagen.

So there were many different microneedling devices. There are a dermaroller, which is a non mechanical device where you just roll these little needles on the skin. There’s also a Dermastamp which you stamp onto the skin and you can fill this with serum or different products. And these are really meant for in home use to treat the skin at home.

This is a microneedle pen and this microneedle pen has different speeds for working on different areas of the skin. And it also has different depths. These are little needle cartridges. that connect onto the pen that go into the skin and I offer a four hour training on using a microneedle pen for wrinkles, hair loss and also for acne and acne scars, so how to actually use a microneedle pen.

the pen. So here are some before and after photos of acne and acne scars. This one was microneedling and this one was just using a derma roller. So some of the contraindications are if someone has actual acne. active pustule acne, you don’t want to be microneedling over that. If there’s any sort of infection going on, you don’t want to microneedle over that.

If the person is pregnant, you don’t want to be using a microneedle pen. You could do some derma rolling, but the biggest concern is infection and introducing any sort of infection. So you would want to make You were microneedling with a derma roller or a derma stamp that your device was clean and sterile.

With a microneedle pen, the cartridges are thrown out, but since you’re going deeper, you do run more of a risk of infection. Other contraindications are keloid scars, any sort of bleeding disorder, any sort of skin condition. or if the person is using Retin A or Tretinonin this thins the skin and can be a contraindication.

Other contraindications are if the person has open wounds or cuts, any allergies to any of the ingredients in the numbing agent that you might use or the serum any sort of autoimmune disorder. And, or if they have active cancer or they’re going through radiation therapy.

Some precautions that you would use are to make sure, as I mentioned, that your tools are sterile. And you might also want to do some patch testing, especially if the person has darker skin. And you want to avoid any overly sensitive areas, especially areas where the skin is very thin, the red part of the lips.

inside the orbital rim. As I mentioned do a patch test and avoid any areas where there’s pustule apnea, rosacea, or broken skin. When you’re thinking about different types of skin that might be better suited to microneedling, you want to think about the Fitzpatrick scale. So that’s how dark someone’s skin is.

So darker skin types are more prone to Inflammation sorry, post inflammatory pigmentation. So you would want a patch test if someone has dark skin. And then you would adjust the needle depth and frequency for sensitive or any reactive skin types. So what this boils down to is really doing a thorough consultation to meet the person’s individual needs.

As far as results, typically people come once a month and results are typically seen within three to six treatments. And during the time the person is getting treated, they should avoid using any retinoids, exfoliants, whether it’s a physical exfoliant like a scrub or a chemical exfoliant like alpha or a beta hydroxy acid.

They should not have any exposure to direct sunlight for 48 hours after the treatment. When you’re doing, whether it’s microneedling or dermal rolling, you want to use some sort of a serum when you’re doing your treatment. And then post treatment you want to have something such as aloe, arnica, something that will soothe the skin.

And when you’re treating the skin during the treatment, having something with Peptides, hyaluronic acid, vitamin C, collagen, these are all good ingredients to have when you’re doing the micrometaling. So the hyaluronic acid will hydrate the skin, and it also helps post procedure. The vitamin C helps to brighten the skin, and as I mentioned, you want to avoid any kind of harsh chemicals.

So the first thing that you do is you clean the skin, and then you have to prepare the skin. That might mean putting on a numbing cream if the person wants numbing cream. And then you are going to start in the less sensitive areas. Possibly on the forehead and then work your way down work in different sections.

And this will give, so instead of trying to do the whole face at once, you work in a small area and you don’t wait for the skin to get pink before you go to the next area. Okay. You would treat the area like four times in each direction and then move on to the next area. You can always go back. It is a light to moderate pressure and really the device itself will do the work.

You don’t have to press too hard because that can cause trauma to the skin. And I’m sorry for my slide, really formatted it looks like. Some of the words got cut off.

Typically for acne scars, superficial scars will respond well to depths between 5 to 1. 0 millimeters. Deeper scars like those ice pick scars or the boxcar scars require 1. 5 to 2. 0 millimeter especially if they’re on the chest or the back. I would probably say more 1. 0 to 1. 5 and see how that works when you’re working on the face.

As far as the frequency for active acne, you are going to work every four to six weeks, very shallow depth, and again, don’t treat any active pustules or you don’t want to spread the bacteria. and you want to use an anti inflammatory serum and acne targeted serums and treatments afterwards. If it’s a scar, same thing every four to six weeks, you’re going to go a little deeper depending on how severe the scar is.

And as I mentioned, they should notice a difference within three to six weeks. months of treatment. Once the desired results are achieved, they can come in for maintenance every three to six months to maintain the skin health and they should be doing care at home with products. After the treatment, gentle cleansers, avoid sun exposure, use your serums.

They should cleanse with a mild non fragrance cleanser, and a hydrating serum. So some of the things that might occur afterwards and so redness, swelling, peeling or normal infection is very rare, but it is certainly a possibility. But typically, you get mild redness, peeling, swelling, which subside within 24 to 48 hours.

Something that’s great is if you can combine the microneedling with other therapies, either within the treatment or in the case of acupuncture, you would alternate. So what I do with my patients with acupuncture, is I will give them three weekly acupuncture treatments during the month, facial acupuncture.

Then on the fourth treatment, I will do microneedling. And so I work the microneedling in. Red light therapy can be used or LED therapy can be used, especially the blue light because that helps to kill the bacteria. of the acne and putting these things in combination can really yield the greatest benefits.

It’s very important that you document everything, keep a record of all the treatments, including the needle depth, what products were used, and the client’s symptoms. responses or reactions, and make sure to schedule the follow up so you can monitor the progress. Always use before and after photos so you can document the changes because people don’t always notice the changes.

And then by doing the patient education, you can ensure the best safest outcome for your patient. So this is my social my website is FacialAcupunctureClasses. com. I’m on Instagram and Facebook under my name Michelle Gellis and I hope to see you in class sometime.