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You’ve Been Approved for 25 Visits – Now What? Sam Collins

But let’s talk about today’s program. Let’s talk about when you see a policy that says they get 25 visits.

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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.

Greetings, friends and colleagues. This is Sam Collins, your coding and billing expert for Acupuncture, the American Acupuncture Council, the American Acupuncture Council Network. But more importantly to you, your success is ours. We’re always here to try to make sure that you have all the best available information to make your practice thrive.

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I want you to be the best possible provider and focus on that. Allow us the chance, the Council, to be that support service for you, where we’re there to help you with all the nuances. That’s what network members get from us. But let’s talk about today’s program. Let’s talk about when you see a policy that says they get 25 visits.

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What does that really mean? Or when it says we have 40, 80, or whatever, what about some plans that it’s actually unlimited? Does it really mean that? So let’s go to the slides. Let’s talk about this when we get policies that tell us the amount of visits that someone has. What does it really mean when a policy allows 25 visits?

Does it mean they get 25 automatically? That no matter what, I hope all of you are going, well, no, that’s probably not true. What we have to have every time is it has to be medically necessary. It’s not going to be just an automatic. It’s going to be, should it come up as something that’s necessary? In other words, if a person says, I feel fine, I feel perfect, but I want to get my 25 visits.

Will the insurance allow that? And that’s where we have some difficulty because when patients have policies like these, they have the false pretense that, Oh good, that means I can come two times per month this whole year and the rest of my life. Now, as much as I would love that to be true, that isn’t always medically necessary.

So we do have to keep in mind that we need to learn to navigate and achieve the optimum utilization, make sure patients are aware. Now realize, many people have conditions. Pain and otherwise. That could require some acupuncture services that will max out those visits and could be that way, but we have to make sure, do we have it medically necessary?

Is it automatic? Does it mean they get to use it at their discretion, two per month? But what about maintenance? Will that be covered? Well, first we have to think of what is medically necessary because in order to have 25 visits, you’re always going to say they’re looking for medical necessity, something that is necessary for the patient.

And that must be delivered with defined, reasonable, and evidence based goals. Now, realize As an acupuncturist, there’s many things you can treat beyond just simple what I call the physical therapy chiropractic side, which is musculoskeletal and pain. It can go beyond that, but we still have to have evidence of the changes.

It must be based on the patient’s presentation of their diagnosis. Make sure it’s a covered diagnosis. That’s probably going to be number one. For a patient to be covered for acupuncture, you have to find out what are the covered diagnosis. By example, Aetna and Cigna have very similar covered diagnosis, but there are many more with Cigna than with Aetna.

But what about Blue Cross Blue Shield? So it’s sometimes learning that nuance. This is what we do for you at Seminars, of course. So make sure we have the diagnosis, but then also, what is the severity? What are the clinical findings that demonstrate the need for care? It says, continuation of treatment is contingent upon progression towards defined treatment goals evidenced by specific significant objective functional improvements.

Notice it says here, outcome assessment scales, range of motion. The good news is, pain, which is the number one thing acupuncturists treat, is always going to cause some dysfunction of some type. Their function is going to be less based upon their pain. So talk about when a patient says they’re having pain, even if it’s headaches, what is this headache causing you to have problems with?

Oh my goodness, I couldn’t work. I can’t work more than 30 minutes at a time. We’re had to take a day off. All these things demonstrating some type of evidence of a functional change. I think acupuncture works very well here. Think of how many types of doctors you can see, but how many can you treat with that when you leave the visit, You literally feel better.

I mean, if you go to a medical doctor with a headache, and I’m not saying this is a negative, what is a medical doctor going to do? Evaluate you and make sure it’s not nothing more severe, but then otherwise give you a script for pain medication. They call it in by the time you can get the prescription filled, hours later, maybe the next day, then you take it by then.

Maybe the headache was gone on its own or it can help. Someone comes to you with a headache. How many of you have witnessed what I call the miracle of acupuncture? that they leave going, Oh my God, I cannot believe that worked. I’m without a headache and I came in with one. That happens all the time. So we want to demonstrate that the patient has changes.

So always rely on how you document as demonstrating the number of visits. Cause 25 visits are certainly reasonable. If you can show they have a headache after a certain number of visits or time, the headache is gone or reduced. Now, can that headache return? Absolutely. So it’s not a never ending. It says certain conditions require to be co managed by a medical provider.

If you’re dealing with, some plans cover addictions, strokes. Cancer related. Well, those you’d want to be working with them. By the way, I took this directly from Cygnus coverage and it says, medically necessary services including monitoring outcomes with progress and change in treatment, with a withdrawal of treatment if the patient is no longer improving.

I mean, let’s face it, how many patients are going to continue to come to you if you’re not helping? This is the hard part because patients start to understand the value. and necessity of care. Our job is when do we demonstrate that that care is no longer medically necessary from an insurance standpoint.

I think so long as we can demonstrate there’s ebbs and flows and we’re showing improvement or can be supportive, I think we’re going to be on the right track. Just be careful. Maintenance or non covered means it’s intended to improve or maintain general physical condition. I don’t disagree with that. I think certainly healthcare should be part of that, but that’s not what our insurance is for, is it?

Insurance says Sickness or disease. So it’s not about keeping you healthy. I wish we would no longer call it health insurance. We should call it sick insurance. It says maintenance acupuncture services when significant therapeutic improvement is not expected. So it’s maintenance when it’s not expected.

Now that doesn’t mean it has to improve every time. So when someone says there’s 25 visits during that 25 visits, if we’re noticing a continuance of improvement medically necessary, the difference is, How do we demonstrate it? Are you using outcomes to do that? Are you giving me the true objective changes?

Don’t tell me or rely on the patient feels a little better. That’s certainly not going to be adequate. That’s part of it, but they feel better. How? What functional change? What objective change do we have? It says services that do not require the skills of a qualified provider, such as acupuncture, are limited to that can be practiced independently and self administered.

So in other words, if you’re just saying we’re coming in and just doing exercises. only. They’re going to say, well, why couldn’t they continue that at home? So you always want to show that it requires a skill, meaning they’re getting true acupuncture services. Home exercise services can be formed safely and independently.

It can’t be just that. Now, should exercise be part of the care plan? You bet. But I want you to keep in mind, when I go to an acupuncturist, you know what I want? Acupuncture. Chances are we’ve tried exercise. Now that doesn’t mean you’re not going to give me some better ones. And I’ll say doing Qigong type exercises, if you will, or physical therapy type, or just gym type are all helpful.

and could be part of it, but the thing that separates you is going to be the acupuncture. So keep in mind, there is something though that insurances will cover, particularly on some of these visits, what they call supportive care. And it says supportive care can be referred to as ongoing or long term treatment or care, and it may be necessary as treatment for individuals who have reached maximum benefit.

In other words, they’ve reached maximum benefit, but you notice right after you withdraw care, They begin to have a significant drop off. Now, what we want to do, make sure we’re showing, because of that drop off, they’ve been doing home exercise. They’re doing things to help prevent it, but it doesn’t do it.

So, you want to demonstrate that the patient can get ongoing improvement. with the care. When it falls off, we get them back treating again. So keep in mind what they don’t cover though is a true maintenance. Supportive is different from maintenance. Supportive is in the absence of care, it significantly drops off.

Demonstrate that objectively and subjectively. If we’re just saying it stays the same and we don’t want it to get worse, that’s a difference. That’s where this comes in. The member’s symptoms are neither regressing or improving, is considered not medically necessary. If no clinical benefits can be appreciated after four weeks of acupuncture, then why?

Now, notice what it says here. They’re initially giving everyone probably four weeks. Now, four weeks for you could be one time a week. For another person, it could be two times a week. So, keep in mind, it’s not just number of visits, but over a time period. There are some service providers who might do one visit a week.

What I want you thinking of is, if I give care, Can I show improvement? No matter how many number of visits they’ll have, they’ll allow it. I have an office, and this is not a joke, they’ve treated someone probably the last, and I’m not going to over exaggerate it, for sure the last two years, I can say for sure, and they’ve treated this person 40 plus times every single year.

Now, grant you, they have a very significant chronic condition, arthritic changes, and so forth, but they don’t treat 40 continuously. They’ll treat usually 10 or 15 per an episode. They may not see them for weeks, maybe a month, and then treat another 10 or 15. And that same thing has gone on. What they haven’t done is just treat them every other week.

Now, some people might say, maybe that’s better. Well, unfortunately, that’s not how insurance works. So we want to make sure that we can demonstrate always meaningful improvement in symptoms and objective changes. And here’s a good example of a plan like this. This is the Costco plan under it. And I’ll just have you go to the first part here.

It says changes in coverage for chiropractic services. You’re thinking, what? Bear with me and let’s read on. Currently, chiropractic services are covered as an alternative care benefit. You pay a co pay for each covered chiropractic visit, and you’re limited to a combined total of 20 alternative care notice.

Acupuncture, chiropractic, homeopath, and naturopath. Costco is very generous. So what is that telling us? Do we get 20 visits per year? for acupuncture combined with others. But notice what began this year, January 21st, they’re allowing a little bit more for chiropractic, but it’s all based on medical necessity.

They’ll allow up to 90 visits per year. So what I want to highlight is visits, if they give you 90, 20, you still have to demonstrate the patient can get better as a result of the care. That doesn’t mean we’re curing, but maybe we’re getting to a point where they remain functional. And when that dysfunction drops, We continue treating.

Be careful. I think we’re the ones that have to explain to a patient. 25 visits doesn’t mean automatic visits. 25 visits still comes back to medical necessity. So we’ve got to give our patients a financial agreement. I hope all of you are doing something like this. It’s part of the no surprise, regardless of what a patient thinks is covered.

We want to put this out there. Many insurance policies do cover acupuncture care, but this office makes no representation that yours does. Insurance policies may vary greatly in terms of deductible and percentage of coverage for acupuncture care. In other words, we’re going to do the best job we can to get your plan to cover.

We’re not promising anything. What we’re promising is good care and that ultimately you will be personally responsible for the payment of your deductible as well as any unpaid balances. We go further to say if you have insurance, we’ll bill as a courtesy. Of course we will, but payment for your deductibles if it has not been met as your responsibility.

Your copay is due as services are rendered. What we want to do is give patients good quality care. And here’s something to keep in mind. Your practice as a cash practitioner is important, but it’s even the same when it comes to insurance. Insurance pays part of it. It’s just easier for someone to come in when they have insurance that pays part of it.

I want to access that, but I don’t want to give a false sense of security. Think of it this way. When someone really needs care, they pay for it. There’s a value. We want to continue to have that value, whether there’s insurance or not, whether it’s unlimited visits, that the patient understands it. Keep in mind.

Acupuncture care works really, really well. That’s the medical necessity. But does your documentation present that? This is one of the common problems I see when I have offices I work with in dealing with when they get denials or non payments. How do we fix that? Well, demonstrate the patient made, the treatment made the patient better.

I would implore all of you, acupuncture works really well, but if you look objectively in your notes, Can you see that in an evidenced way? I’m going to recommend that you always use an outcome assessment on every single patient. Even if it’s cash, by the way. Get an outcome assessment. It demonstrates objectively how the patient is changing.

The two that I like the best are the general pain index. The other is the pain interference, the short form. The latter is the one the VA is emphasizing. If you’ve attended a seminar with me, you’ve received them. If you’re a network member, But start using things that show acupuncture works. It’s your way of putting a person on a scale and show they’ve lost weight.

Acupuncture is a phenomenal profession, but you have to make sure how do I navigate to continue to increase my patient base, which means also increasing your volume of patients by volume of income. Because ultimately, remember, you are a business provider and we’ve got to make business decisions. So I always want to be there to help you navigate that as the American Acupuncture Council does.

So until next time, my friends, I wish you the very, very best.

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What is Amygdalization? – Dr. Martha Lucas

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Dr. Martha Lucas, today we are going to talk about amygdalizing, and I want to thank the American Acupuncture Council for giving me the opportunity to share this information with you. You can also find information on LucasTeachings. com, my teaching website. So my practice is located in Denver, Colorado, but I love to teach.

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Teaching all over and having opportunities like this to spread the word about how wonderful Chinese medicine is. So today’s topic is something that I have called amygdalizing. And so I’m going to talk to you about telling your patients to amygdalize. Now, the amygdala is a part of our brain. It’s involved in our stress response, and a friend of mine and I have been studying the amygdala for quite a while in terms of how it is related, especially to anxiety, but anxiety and depression in our patients.

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Kathleen is one of my Pulse diagnosis students from years and years ago, and we’ve kept in touch all these years about how important the proper diagnosis is to help our patients find the cause or help us find the cause of their condition, because that’s what Chinese medicine is about, right?

It’s essentially a preventive medicine, so we want to see our patients to prevent. Conditions, in other words, keep them healthy. You all know the old story about the ancient medical doctors and how you went to see them all the time to stay healthy and you paid them, but if you turned up sick, they didn’t get paid because they’re supposed to keep you healthy.

Now, in our culture, we only we might go see our doctor once a year for our annual exam, but we usually only go when we’re sick. So it is an educational thing to get your patients to understand. You need to come see me. Let’s say they start with a symptom. Come see me. We get you quote unquote cured.

We get your symptoms to go away. We get you healthy again, and then see you in a month. That’s what I tell all my patients. I need to see you twice a week for a couple of weeks, and once a week, then every 10 days, and two weeks, and then see you in a month when you’re healthy. Because I’m getting them back to the time where I can prevent their conditions.

So I love to treat emotions. Emotions are, I, in my pulse diagnosis system, we can feel the emotions in the pulse. Like worry makes the earth, spleen, stomach, pulse go backward toward the kidneys. Part of the problem with that is, number one, it’s taking away from the kidney energy in a perverse way. And number two, it’s not connecting with the lung, large intestine, metal, and earth and metal are our immune system, right?

So people are going to show up with some sort of immune or skin or hair condition, along with their worry causing this to happen. Terms of anxiety and depression, we feel depression, chronic depression, current depression in the liver pulse, the liver gallbladder pulse. And then anxiety is felt mostly in the heart, but that combination of the liver and the heart.

So I have for years been telling my patients when I feel their anxiety to what I call amygdalize. Now, why choose the amygdala as the choice of organs for them to calm down? And remember, the master said that, and I remember this from the first week of Chinese medicine school, and I Really, honestly, at that time, I thought it was a little bit of a crazy thing to say.

I’m a research psychologist by training in the Western medicine, so to say, Oh, emotions cause all physical disease made me feel like, what? Are you kidding? But as I’m feeling people’s pulses, you can feel that back and forth movement, or the scattered of the heart pulse, is eventually causing a physical symptom.

And if you want to think about it, and when we talk about the amygdala, you will know, it’s a physical disease. The amygdala is a physical organ in our body. We’re feeling the person’s anxiety and or depression, and that’s physically in their body. We’ve managed to get this idea of anxiety and depression down to a physical problem.

Now, sure, we have bacteria, viruses, that sort of thing causes physical disease, but also your patient’s emotions getting stuck. Your patient’s emotions, like if the heart pulse is scattered, blood flow isn’t going to be very good, right? This is why our fertility patients need treatment on the heart because that blood flow is going to eventually go to the uterus.

And without that connection, people are not going to be able to get pregnant very easily. So we’re going to be talking about the physical brain and how we’re going to deal with that in Chinese medicine. But it all started with this idea about that. Emotions caused all physical disease. And now of course, I’m big on treating emotions.

I love to treat emotions. I think we all need to let our patients know that Chinese acupuncture, Chinese medicine doesn’t only treat fertility and pain. I think those are two of the big topics, but we also treat the person’s emotions and their spirit. So the amygdala is a little tiny part of your brain, but it has a big function.

It’s one of the major. are the major processing center for your emotions. It also links the brain with other brain activities like memories, learning, and our senses. So that’s why sometimes when people have a panic attack, they have all of their senses seem to be involved in that. But it’s main, going to be talking about is how it can cause disruptive feelings like anxiety and depression.

It’s inside your temporal lobe. As I said, it plays a key role in emotions and memory and learning and It’s actually a little structure, but it’s part of a bigger network called the limbic system. And we all remember that the limbic system has to do with emotions. It’s part of our, very important part of our survival, because without fear in the, what I call the old days, when we were, threatened by tigers at the door and dying in childbirth more and that sort of thing.

We had to have fear, like that idea that the hair stands up on end on your arms when we’re fearful or we are worried for our own survival. If you’ve ever almost been hit by a car, you will know that your hair stands on end because you, Your survival was threatened. So these parts of the brain, including the amygdala, what we call detect danger.

But now the danger isn’t a tiger at the door. The danger is we can’t pay our bills. We’re afraid we’re not going to pass an exam. Our business has declined. Maybe we’re having a little bit of a relationship problem. Those are now the issues that really aren’t what you would call survival. They’re not really, I’m going to die because I can’t pay this bill.

I can do other things about not being able to pay that bill. But the amygdala doesn’t know that. It, all it sees is it’s, Just processing the things that we are seeing and hearing, like literally look at the bill and the amygdala goes into that feeling of, oh my gosh, I’m going to die. So we get fear, we can get aggression.

As I said, it’s a part of learning through rewards and punishment. So again, we can cognitively train it to learn this is not a survival, death threat. And then with memory, and it also is a part of social communication, which is what amygdalizing is. When I tell my patients to amygdalize, it means that they need to just express the emotion they’re feeling, express the situation to someone.

In fact, they don’t even need to. They don’t even need feedback. It’s not I need to have a conversation with somebody about this. In fact, my friend and I do emails back and forth and we’ll say, I need to amygdalize in the subject line, which means to our friend, my friend and I, you don’t have to call me back.

You don’t have to even email back. I just am having this situation. I need to express it. I’m going to say it to you or leave a message, leave a phone message. Hey, this is an amygdalization thing. phone voicemail and just blah, blah, blah, blah, blah, blah, what’s happening because we need to express that. And the masters were right about that.

I tell all my patients, your emotions are better in, sorry, your emotions are better out than in. They’re better expressed than held in. It’s the holding in that creates the stagnation and the weakness, the deficiencies or excess. Stagnation can be. either deficiency or excess, but it’s the holding in of the emotion that’s going to lead to some physical problem or anxiety and depression, which we consider emotional problems.

So they were right about that. Now, I always tell my patients, I’m not suggesting that we all become raging maniacs and road ragers. I’m just saying that you need to say it. You’ve had a bad day at work. Your boss has been a jerk. You just need to get in your car and do the, Oh my boss, blah, blah, blah, blah, blah.

Or you’re sad about something, I’m sad about this particular thing happening. And I always tell them if you’re sad and you can cry, or you’re crying with words processes things faster than just crying with your frontal lobe and your amygdala going on and on inside this loop, right?

That’s what worry does to the pulses, as I mentioned earlier. It’s a loop between earth and the kidneys back and forth. And that’s very dangerous to our health. So what the amygdala ization does, which that’s a phrase I’ve coined, amygdalize and amygdalization, is it helps your amygdala calm down.

It helps the neurons because what the amygdala is made of is neurons and they’re sending and relaying electrical and chemical signals throughout your brain and nervous system so that you see a threat, your bill, and then these neurons start to go through your whole brain, your whole nervous system. And It’s the protective cells for those nerves don’t recognize that this is not a threat to my life.

When we start to have anxiety disorders, PTSD, any mood disorder, panic disorder, these phobias, fearful things, these are all how These are all affected or started in the amygdala. So again, we need to be always thinking about getting that out for our mental health because your amygdala can get hijacked.

If we don’t recognize that this is not a danger to my life, then those emergency signals are just going to keep going and going and going and other parts of your brain are going to react you. to that. So you might have a startle reflex. As I said, you’re going to have anxiety or depression.

It’s an emotional hijack, if you will. So what the amygdala starts in your central nervous system is this process to protect yourself, protect your body, from a dangerous situation or from danger. So again, this helps in a dangerous situation, right? If a car is coming and your ears hear it and you’re on your bike and you’re, you suddenly get a fight or flight response, that’s going to save your life.

So it’s protecting your body from danger by putting you in fight or flight. But now, as I said earlier, The fight or flight isn’t survival. The fight or flight is worried about having a fight with our partner worrying about our business, having to pay some bills, something, our child is a little sick, but we turn it into a bigger worry.

Again, we need to. Nip that in the bud. So then that’s when I tell my patients to amygdalize. I say that’s not a life threatening thing, but your body feels like it’s life threatening. So you need to not neglect your mental health. You need to realize that your physical body is your mental health.

So again, talking to a friend, you don’t need feedback. So what I tell my patients is you don’t need to. Say to a friend, Oh, I need to talk this over with you. You just need to tell him, Hey, my practitioner told me to do this thing called amygdalizing, which means I’m just going to talk about the thing.

I’m just going to repeat the thing so I can get it out of my mind, get it out in a situation where I get my brain to realize, Oh, actually this is a bill. I can do something about that. I can call the company. I can make payments. I’m not going to die. And we can calm ourselves down by doing what the master said, which is getting the emotional, getting the emotion expressed right in a healthy way, not being over angry, not, it.

Not yelling at anyone, not hurting anyone. We just get the emotion out by expressing it to someone. Or like I said I call it talking crying is a great way to get it out and process it if you’re a crier. If you’re a crier and you say the words, I miss him, I’m in your frontal lobe. Let’s say it’s that you miss someone.

Your frontal lobe just gets in that loop. I miss him. I miss him. I miss him. I miss him. I miss him. I miss him. But if You can’t say that out loud when you’re crying. You can’t possibly say, I miss him. I miss him. I miss him. I miss him. I miss him. Like it goes on in your frontal lobe. You’ll start to process it.

I miss him because he’s going to a different school now, but Hey, there are airplanes, there are cars. I can still see him. He’s growing up, whatever it is that you’re trying to process. That little bit of grief, but you need to process it. I remember my mother died suddenly and so when I went to see my doctor for my annual exam, she said I was crying because I just reported that my mother died a couple months ago or whatever, and she said, Oh, do you need some antidepressants?

I said, No, I don’t need antidepressants. My mother just dropped dead. I need to cry. is what I need. You put me on antidepressants, it’s going to make me stop crying because that’s what they’re really good at. You can feel that in the pulses. You can feel the liver energy go up to the heart and stop when a person is on antidepressants.

We of course need that energy to get over, over to the spirit, right? Over to the heart to keep the heart blood flowing and the spirit flowing well. I know for that from Chinese medicine. Now, if I wasn’t a Chinese medicine practitioner, I wouldn’t have needed that. I wouldn’t have known that. And maybe I would have said, sure, let me have some antidepressants for a while.

But we all know as practitioners, we have to get that depressed energy flowing. Get that grief, get that shock going because otherwise my kidneys were going to suffer, right? And the last thing.

When you feel the emotions in the patient’s pulses, sometimes get them to amygdalize while your hands are on the pulses. And I’ve done it plenty of times the other way. I make a joke in my pulse diagnosis class about how, you know what, you want to feel somebody’s anger pulse in the liver, talk to them about their divorce.

It’s the opposite too. I can tell them, amygdalize, get, and old childhood trauma. They’re amygdalizing in front of me about that and you can feel their earth pulse Sink down deep because this is something they’ve had in their system for a long time about not being nurtured So at any rate I wanted to introduce you to this technique I call amygdalizing able to tell your patients to amygdalize and If you have any questions, you can contact me at LucasTeachings.

com or my private practice site is AcupunctureWoman. com and I’ll be happy to answer your questions. I love to help practitioners be better at our craft because I really, after more than 25 years, I really do believe that Chinese medicine rocks. Again, I want to thank the American Acupuncture Council for this opportunity to speak with you and, as I said Feel free to contact me if you have any questions.

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Benefits of Microneedling versus Cosmetic Acupuncture – Michelle Gellis

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Pelvic Floor and Menstruation – Krystal Couture

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Hello, everyone, and welcome! I’m Dr. Krystal Lynn Couture, and today we’ll be talking about the pelvic floor and menstruation. But first, I want to take a moment to extend my abundant gratitude to the AAC, the American Acupuncture Council, for hosting this educational video, as well as other amazing videos that are on their vlog.

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Seriously, check it out. There are tons of clinical pearls and nuggets of wisdom on all topics acupuncture and Chinese medicine. So let’s get started with today’s topic. the pelvic floor and menstruation.

In today’s mini workshop, we’re going to be talking a little bit about the history of menstruation and how it was viewed through society. We’ll talk about some Chinese medicine philosophy, including what the Siwen says about menstruation. We’ll talk about the elemental cycles as well as the hormones.

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We’ll also talk very briefly about some of the common dysfunctions that are associated with menstruation, such as dysmenorrhea, or painful menstruation, irregular cycles, menorrhagia, which is heavy bleeding, or amenorrhea, which is the absence of the menstrual cycle. We’ll also chat about the connection to the pelvic floor throughout the menstrual cycle.

Let’s get into it. So let’s look at the Western history first. And there are some pretty interesting things to note here. In ancient Greece and Rome, in antiquity, menstruation was often viewed with a mix of awe and fear. The ancient Greek physicians, like Hippocrates, described menstruation as a natural process but it was surrounded by a variety of superstitions.

As we moved into the medieval period, menstruation was actually framed within religious and moral contexts, and the women’s menstrual cycles were actually associated with sin or divine punishment. Now moving into the 19th and early 20th century, This was our first sort of win, if we can call it that.

Menstruation was actually considered a biological process and given a scientific definition. And this was basic in that the blood and mucosal tissue fluid flowed once monthly throughout the vaginal opening. Now, as we move into the 1960s and 1970s, Okay, so this is really recent. Women have been bleeding since the beginning of time, and yet it was the 1960s and 70s when feminists began to challenge the stigma that surrounded menstruation.

And there was an increased awareness of the impact that menstruation can have on a woman’s social and professional life. Finally, in the state of present feminism, the world has recently started talking about menstruation. Amazing! And there are some really big voices out there in both Western and Chinese medicine that are setting the stage for women to learn about their bodies, to talk about menstruation, and to honor their cycles.

As a woman, this feels huge because there are so many questions that I feel women have regarding menstruation. And growing up in the 80s and the 90s, as a child during that time, I didn’t ask questions. I wondered what was happening in my body, but it didn’t seem like there was an opportunity to ask those questions.

I didn’t feel like there was a stigma, but there wasn’t an opportunity either. And I think of women feel that way. And a lot of women continue to feel that way. So as acupuncturists, we’ve got this beautiful opportunity to help clients understand their bodies, to help them honor their monthly bleed, to help them gain some knowledge.

about what’s happening within their biological system, within their ecosystem, so that they can then, one, get help when they need it, two, identify when something doesn’t feel right, and three, feel like what’s happening is okay. And it’s normal and there shouldn’t be shame and other negative emotions associated with it.

I love this quote from Christiane Northrup, an MD. She says, The macrocosm cycles of nature, such as the ebb and flow of the tides and the changes of seasons, are reflected on a smaller scale within the menstrual cycle. I think if we can instill One connection for our clients that are coming to see us for menstrual support.

It’s that the menstrual cycle is natural and it is called a cycle for a reason. It is not a stable process within the body. The hormones are changing throughout that cycle. And it is okay to feel differently. throughout the month. It’s okay that we might have more energy at some times and a little bit less energy at other times and that our output and our input might be gauged differently depending on what’s happening in our cycle and our own unique ways of processing that.

And again, as acupuncturists, if we can support our clients to feel into the cycles, to understand that just like the seasons outside change, the season in our body is changing on a monthly basis. And that’s okay. That’s brilliant. In fact, that’s an opportunity, not a negative subset.

So the Siwen, two times seven, the age of 14, the Du of heaven rises. The Ren channel begins to flow and the Chang is flourishing. Menstruation comes regularly.

In Chinese philosophy, when we’re talking about menstruation, I want to try to bridge the gap here a little bit between the tangible of what’s happening from a Western perspective, and the more ethereal that’s happening from an Eastern perspective, or Chinese. Ethereal emotional. So during phase one, we’ll call that menstruation.

The bleed. This is usually days one to four. Most of the hormones are going to drop off during this time. And of course this is when the uterine lining is shedding if one does not become pregnant. The uterus is cleansing out the old blood. In Chinese medicine philosophy, this is the time to regulate the flow of the blood and qi.

So that means that because so much is happening in the body, we don’t want to put a lot of demands on the body. We want to encourage our clients to eat easily digestible, protein rich foods like soups and stews with Iron in them as well that are going to help them to continue to regulate that flow and also build the blood throughout the cycle.

We want to prevent stagnation of blood. which can come in the form of endometriosis and excessive bleeding, which of course that can be our depletion, right? So during this time, I like to encourage clients to conserve their qi. I encourage them to rest during this time. If they’re going to do exercise to be doing exercise that is low impact like yoga or meditation, Or Qigong.

This is not the time to encourage your client to be going for, their strongest pump or something like that because the body wants to utilize that energy. And as acupuncturists we know, there’s only a certain amount of energy to go around the body. And at certain times, like menstruation, that energy is concentrated in the uterus, which, is why we feel a little bit more fatigued, which is why we feel a little bit more depleted.

The uterus is taking all of that energy to release the uterine lining, to let go, to shed. So when we start to shunt that energy in other places, what we can have is then the uterus not having the energy it needs. So resting, staying warm, gentle exercise, avoiding sex during menstruation is really important because the process of the bleed is a downward and outward process, right?

It is a releasing process. Taking in during a releasing process goes against, in Chinese medicine philosophy, what is naturally occurring in the body. And that’s the key. Helping our clients just to tap into the logic of what is their body saying and using the simple cues of how their body responds.

To then make choices. Avoiding heavy lifting, of course, and hydrating well. This is one of my big tips for clients is to encourage them to stay maximally hydrated. The blood in essence is water. It has that capacity to it, so we want to keep the fluids in the body flowing. We want to keep the digestive tract flowing.

We don’t want this to be a time when things are bound up. Let’s talk about phase 2, the follicular phase. So this is going to be approximately days 5 to 11. During this time, this is going to be when FSH is secreted follicle stimulating hormone. Follicles develop during this phase, and estrogen is secreted from the follicles.

FSH is secreted from the follicles. There’s the activation of the egg and the endometrium thickens. The Chinese medicine philosophy here is that it’s time to nourish the blood and nourish the yin. We also want, for fertility’s sake, we also really want to be strengthening that uterine lining and the follicles, which means that a diet should include proteins, it should include leafy greens, and it also should include foods that are moistening.

So sweet potatoes are a great example of a food that is moistening. During this time, we want energy to be contained, but we can have output. So that means we can start to move our bodies more. We can start to go to, maybe a hot yoga class. We can start to get back into the gym, doing some lifting, some of those activities that make you sweat.

a little bit. Ideally, you still don’t want your peak activity to be during this time, but you can definitely ramp up to, let’s say, what one would call their normal activity level. So if their normal activity level is going out and hiking nine miles three times a week, Living in Boulder, Colorado or something, then they should be able to do that with comfort during that time.

But they’ll save their, big hike, their 20 mile long weekend hike for a different season in the menstrual cycle. So let’s talk about ovulation. Days 12 to 16, approximately. During this time, we’re gonna see luteinizing hormone LH surge. We’re going to see the basal body temperature dip down and then increase.

The egg is going to be released from the ovary, okay? The cervix is going to start to soften. Cervical mucus is also going to thin, so it’s going to be like the consistency of egg whites. This is so that the sperm can easily pass through and fertilize the egg. Now, during this time, the Chinese medicine philosophy is really such that we want qi and blood to be moving.

There’s going to be a lot of energy in the system. We want to use pungent foods to help us move that qi and blood on a dietary level, and we want to strengthen the yang. So this means this is our time for vigorous exercise. Obviously, if one is trying to get pregnant, that there’s some exceptions here.

But this is the time to do that super long hike. This is the time in one cycle, if they’re going to be doing a triathlon or a marathon, something like that. This is the moment to do it. And then we want to encourage that creative output, that manifestation and expression, right? Because the egg serves as that.

When the egg is unfertilized. We’re not producing a child, but utilizing that energy of creation, that energy of manifestation, that energy of expression, encouraging our clients to get into that slipstream. Progesterone is so important for their spirit during this phase, for them to stay on the path of their Dao.

The final phase we’re going to talk about, phase 4, the Luteal phase, days 17 to 28. So this is when progesterone is going to increase, estrogen is high, and the uterine lining thickens. The Chinese medicine philosophy here is that we need to boost qi. So we can get into this phase of vigorous and competitive exercise until about day 26, leading right up to the bleed, because we don’t want to be utilizing all the energy we’ve got and then bleed the next day, ideally.

So eating lots of veggies to increase fiber. And of course, starting that heavy increase in hydration is really important. during this phase. I wanted to post this image of the balance between yin and yang. So we see when we start off with the menstruation phase on the bottom of the chart there.

We start off with menstruation, go into the follicular phase, ovulation, and then the luteal phase. Of course we’re gonna see the red line is young, the blue line is old. Yin. Now, we’re going to see that Yin and Yang rise in correlation and coordination with each other. Yang becomes Yin during menstruation and Yin becomes Yang during ovulation.

The seasons within. Okay. So let’s think about that phase one, that menstrual phase. This is going to be our inner winter. This is a phase where we have. Blood, we have the element of water, which makes sense, and the seeds or the essence are where we return to. In the spring, our follicular phase, we’re going to have the fluid of yin.

the element of wood, and we’re going to start to see those buds form. During our inner summer, we’re going to have ovulation. This is when yang is building. We have that fire energy, right? And of course the flowers are blooming. In the autumn, the luteal phase, we’ve got the qi, we’ve got the metal element, and then we’ve got those petals starting to shed, right?

And of course, earth remains as the element in between. So just like it does in the seasons when we don’t know if it’s winter or spring, that’s the, that’s Earth, when it’s an equinox, that’s Earth, right? When things are harmonious or we can’t quite tell what they are. That’s that Earth element coming in to provide that balance and totality.

I love explaining a menstrual cycle to clients through the lens of the seasons, because it really gives them like that aha moment, that fresh breath of Oh, it’s okay that I feel this way. Okay. So let’s talk about the hormones. First off, estrogen. Estrogen is going to peak in the days just before ovulation.

It is made in the ovaries and it is secreted by the adrenals as well as the adipose tissue. It thins the cervical mucus. This keeps the walls of the vagina thick and elastic and also lubricated. The estrogen is going to support a healthy libido. It’s also going to regulate the metabolism of litter.

Lipids and our cholesterol levels, so this is really important to consider as well. It stimulates cells to develop insulin to the muscles which actually lowers blood sugar. So I’m putting some of these sort of effects of the hormones in that don’t menstruation, but they’re things that we might commonly see.

with women that we’re treating. So the connection between cholesterol and the collection between blood sugar. Okay. So estrogen also is known to improve muscle mass and strength. Again, makes total sense from Chinese philosophy as to why when the estrogen peaks, that we are really able to start pushing ourselves with exercise, right?

Promotes activity of the osteoblasts. And these are the cells that make bone. So this is important to consider, especially as women age. Finally, estrogen binds to the fibroblasts and supports collagen production. So if you start to put pieces together here, face, aging, collagen, menopause, right? It all comes together.

And finally, estrogen is neuroprotective, which means it supports brain health. Let’s talk about progesterone. It peaks after ovulation in the luteal phase. It is produced by the adrenal cortex and the ovaries. It is produced and secreted by the corpus luteum, and that’s really that uterine lining. So a new corpus luteum is formed during each ovulation.

Thickens the endometrium for fertilized egg to implant and grow. Regulates bleeding during menstruation, prevents ovulation during pregnancy, prepares the mammary glands for lactation, that’s important, and has a reciprocal relationship with thyroid hormone. So if you have a client that is having menstrual challenges and they’ve got a thyroid condition, There’s a link there and a place to start looking might be Progesterone.

Their Western physician may or may not know that there’s a connection there but it’s an important one for us to be aware of and to know especially if they have not had a blood panel done. Let’s talk about LH, luteinizing hormone. Luteinizing hormone surges to cause the egg release, peaking of course at ovulation.

It is secreted from the pituitary gland and it works alongside follicle stimulating hormone, which makes sense. Causes the corpus luteum to produce more progesterone during that luteal phase. It plays an important role in sexual development as well as an important role in fertility. So some of the chromosomal disorders that result in Sexual anomalies are related to luteinizing hormone and follicle stimulating hormone deficiencies during the embryonic development.

Follicle stimulating hormone. It is produced by the pituitary gland, works alongside luteinizing hormone, stimulates follicles, and stimulates follicles. On the ovary to grow and prepare the egg for ovulation plays an important role in the sexual development and of course infertility. So here’s a chart. I actually really like this chart.

Believe it or not, it is from Encyclopedia Britannica in 2013. But it is a great chart that shows The rise and fall of the hormones. It’s another great tool to have in your clinic to be able to show clients what’s going on with their cycle at any given time. Menstruation. In Chinese medicine, a harmonious cycle begins with the kidney supplying Qi to the organ systems that produce the blood and lining of menstruation, while also filling the extraordinary vessels.

which are essentially the reservoirs for the five vital substances. Once these vessels are full, then menstruation can begin. Healthy menstruation is pain free, with bright red blood and a moderate flow. Blood should be minimal. Sorry, blood clots should be minimal. Short cycles are generally caused by excess heat, whereas long cycles are generally caused by excess cold.

So that’s an important one to keep in mind. And to define a short cycle is going to be a cycle that is 26 days or less. Long cycle is going to be 32 days or more, depending on where you use your def you get your definition. But generally speaking, that’s how we’re going to look at the concept of what a short cycle is and what a long cycle is.

So it’s the totality from menstruation, through ovulation. Let’s talk about dysmenorrhea. So dysmenorrhea is painful menstruation, which can include menstruation. It can include pain in the abdomen, the pelvis, the lower back, even the thighs before and or during menstruation. It is also often combined with a feeling of heaviness or pressure, and in severe cases, the pain can be correlated with nausea or vomiting.

Okay, so primary dysmenorrhea is somewhat poorly understood. And it is usually linked to the excess production of prostaglandins, which cause the uterus to contract and shed its lining. That contraction is a bit of an over contraction, which is why there’s pain. Secondary dysmenorrhea is a diagnosis within the organ systems, such as endometriosis, fibroids, pelvic inflammatory disease uterine lining growing into the wall of the uterus.

And of course Stenosis of the cervix. The pain patterns that we usually see with dysmenorrhea are blood stagnation and Qi stagnation. Now blood stagnation is often going to have a sharp, localized, unrelenting pain. There’s going to be commonly blood clots And there will be relief with NSAIDs so non steroidal anti inflammatories would cause relief because they’re going to change the patency of the blood.

Now with Qi stagnation, this is usually going to be a dull, achy, widespread, diffuse type of pain. It’s going to be relieved by pressure, massage, movement, and heat. Let’s talk about irregular cycles, or chaotic menstruation, as they’re often called in Chinese medicine. They are chaotic? Inconsistent and unpredictable.

So the liver stores blood and the kidney stores essence, right? The combination moves qi and blood into the uterus and the extraordinary vessels. Thus, irregular cycles are essentially caused by either liver qi stagnation, kidney indeficiency, or kidney yang deficiency. Liver qi stagnation is going to be marked by scanty, dark blood with clots.

and difficulty releasing the blood. Kidney indeficiency is going to have a component of heat or empty heat. And kidney young deficiency, of course, the opposite is going to have that cold. Now overwork can cause Inconsistency in the filling of the vessels, right? Again, it’s about the distribution of energy.

There’s so only so much in the body. So that overwork, of course, as it affects the kidneys in many ways, it can certainly affect the kidneys in relation to how they move blood and qi into the uterus. Menorrhagia, excessive menstrual bleeding. This is defined as a heavy menstrual flow. Abnormal uterine bleeding.

We have to Define this separately because that is spontaneous and out of cycle bleeding and can also be considered flooding when we look at the Chinese medicine definition. So we’re not going to talk about abnormal uterine bleeding today. We’re going to stick to heavy menstruation or menorrhagia.

So this is often caused by spleen cheat efficiency or blood stagnation or heat in the blood specifically. Now cheat efficiency. Is going to allude to the qi not being firm enough to hold the blood, right? So often we’re gonna see a combination of spleen qi deficiency here or the spleen not controlling the blood with spleen qi deficiency, right?

Blood stagnation is going to create an overfilling of the vessels and the uterus with no place for the blood to go. So it’s a little bit of A little bit of confusion in our mind when we think about this because we say we have stagnation and an overfilling. But what happens essentially if we think of this like a stream in a river yeah, stream or a river, and there’s lots of logs and leaves and stuff like that’s blocking it up.

That’s stagnation, right? And also there’s this overfilling. There’s a seeping of the water. into the land, into the space around that river or that stream, right? So that’s essentially what we have going on when we’ve got blood stagnation. No place for the blood to go, it goes out the uterus. Then we’ve got heat in the blood, and this is essentially heat going to be agitating the blood and causing the blood to just not want to stay in the system.

Finally, amenorrhea. This is the absence of menstruation. We’ve got primary and secondary. Primary, those assigned female at birth who have not menstruated by the age of 18 years old. Secondary, no cycle for three months or more. Any age above 18. This is very often caused by dampness in the uterus. So spleen chi deficiency is often the cause here, creating poor transformation, thus obstruction of the lower jowl and the uterus, which then leads to a series of other problems in patterning, right?

We essentially end up with chi and blood deficiency due to poor nourishment throughout the system or chi and blood stagnation, which is more of an excess condition and the blood is stagnant but not deficient.

So what about menstruation and the pelvic floor? This is an important conversation and one that I have very often with my clients and my students. So there are three components that we’re going to talk about very briefly and basically. One is the muscles, two is inflammation, and three is pressure changes.

Muscles. The changes in estrogen create changes in the muscle suppleness throughout the body. Okay. This also occurs in the pelvic floor. So estrogen is the lowest when we are leading up to and during the monthly bleed. Okay. So what this means is that the suppleness is at its minimal during this time.

There’s also an increase in prostaglandins, which further relaxes the smooth muscle tissue leading up to the shedding of the uterine lining. And of course, the shedding of the uterine lining creates a micro inflammatory response, right? So now we’ve got muscles that are starting to be less supple, we’ve got inflammation, and on top of that, Progesterone increasing can slow digestion, estrogen rising can cause gas and air to be trapped within the intestines, which means we have pressure changes.

So we have some slack muscles, we have inflammation, and we have pressure changes. All of this means that leading up to one’s bleed and during one’s bleed, they can experience increased urinary and bowel incontinence, urinary and bowel frequency, urinary and bowel Urgency, loose stools, of course abdominal distention, and pain leading up to the cycle and during the cycle.

The pelvic floor is directly impacted by what’s happening with the hormones during, leading up to, and during menstruation. Now why is this important for us to know? One, when we’re questioning our clients, when we’re asking them about their cycle, when we’re asking them about their pelvic floor, and the function of their pelvic floor, it’s important for us to know, is the pelvic floor, let’s say weak or tight, all the time?

Or is the pelvic floor just tight? At a disadvantage, a hormonal disadvantage, let’s say, when they are leading up to their cycle. Now, as acupuncturists, we have a brilliant gift of connecting with our clients and understanding a little bit about their bodies on both a Western and an energetic level.

We also have this great tool in our toolkit called acupuncture. And what does acupuncture do? It creates a neuroendocrine effect. So great news about that. We can understand hormones, but we don’t have to totally understand hormones to make a difference within the body because if we understand the pattern and we’re inserting needles into the body, we’re going to elicit a neuroendocrine effect.

What does a neuroendocrine effect do? It balances the hormones. in the body system so we can really make a big impact. And I honestly see a lot of clients that have pelvic floor dysfunction specific to menstruation have a major improvement just from having general acupuncture that isn’t specific to the pelvic floor.

It’s such an amazing benefit. Thank you so much for joining me today. It’s been such an honor to have you with me for this workshop. I want to again take a moment to thank the AAC, the American Acupuncture Council for hosting this video. If you don’t already know, I have recorded a pelvic floor intro, and coming soon, you’ll have the opportunity to watch my fertility, pregnancy, postpartum, and menopause videos in relation to the pelvic floor.

And again, thank you so much for joining me. If you’d like to look at my references, go ahead and just pause this slide. Otherwise, I’ll see you next time. Thanks to the AAC!

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Diagnosis Updates for Acupuncture – AACN

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My friends, it’s Sam Collins, the coding and billing expert for acupuncture for you, the profession, and of course the American Acupuncture Council. And thank you for spending some time with me. This is an important time of year because here’s a riddle for you. When do the 2025 diagnosis begin? Now, the quick answer to that riddle might be Sam, you said 2025, it must be 2025.

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Actually, it’s not. The 2025 diagnosis codes, as they do every year, actually update the October 1st before. The answer to the riddle is, the 2025 diagnosis began October 1st. So make sure that if you’re using one of these codes that I’m going to go through to update your list, to make sure you’re using the most current code for your patient, because if you use an old code, It’s going to be denied.

Now you can see here, or in fact, let’s go to the slides. Let’s go to the slides. Let’s look at it. So the update you’ll see here is the 2025 update is October 1st. You can see there’s 74, 000 diagnosis. Now let’s be realistic. Is an acupuncturist going to ever use anything like 74, 000 diagnosis coords?

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Of course not. However, a lot can be covered because acupuncture, of course, for pain and pain management has a lot of ways of being coded, but you’ll know one of the most common things you’re billed for, or paid for, I should say. In fact, that’s the code that made the biggest change for you. But let’s keep in mind how these work.

The date of service determines the code. So let’s say, by example, you’re billing a patient that you saw in September of this year, but you’re sending the bill in December. or January for that matter. It’s being a little late, but you’re still sending. It doesn’t matter when you send the bill. The date of billing does not affect the code.

It’s the date of service. So if the date of service was prior to October 1st, please use the old code. If the date of service is after, Use the new code. Pretty straightforward and simple. However, let’s talk about what if change. The changes are occurring for lumbar and lumbosacral discs. Now, as an acupuncturist, you might say Sam, I’m not sure that’s very important to me.

Certainly could be as a lot of acupuncturists now are working as the referral person for back pain and pain management for medical doctors. You’re often going to get patients that will have these conditions and often they’re not going to put a code for you. It’s just going to say, Dysdegeneration.

Right now the code is M5136, so pretty straightforward, M5136, that’s fine, but here’s what’s changing. The changes now, they’re going to be a little bit more granular or more specific, where it allows you to describe what’s going on with the person. You’ll notice this first code, M51360, is dysdegeneration to the lumbar region.

with back pain or discogenic back pain, meaning back pain. So that’s pretty straightforward that it is back pain, of course. However, could there be more? There is more. M51. 361, other intervertebral disc degeneration in the lumbar region with lower extremity pain only. Now notice there now is a code that is back pain only or one that’s lower extremity pain.

So many times a person will have disc degeneration and go, man, my leg is killing me. And it’s actually from the disc. So now there’s a code to differentiate that, but there’s also one when it’s combined. So if you have a patient with combined back pain and leg pain, there’s now a code M51362. Clearly a person with back pain and leg pain, a little more severe, of course, meaning more care long term.

So this really, I think, sets up to demonstrate the length of care someone is likely going to need based on a diagnosis. Now, we have back pain. Leg pain and a combination of both, but there’s always this one too, and I’m sure you’ve seen this. There are many people that maybe they went in for some upper back issues, but they did an MRI or x rays to other areas and they found, oh, there’s disc degeneration in the lumbar spine, but it’s asymptomatic at the time.

If there’s disc degeneration that’s asymptomatic, there is now a code. Disc degeneration without mention of pain, In the back or lower extremity pain. I like that. That kind of lends to, that doesn’t mean the person is fine, but it does mean that they’re obviously having disc degeneration and we know they’re going to be closer to having a problem.

So what this does is just add a little more specificity. If you were seeing these codes, please make sure to add these new digits to get that specificity for it. Because if you send it in 5136, It’s going to be rejected unless of course it was before October 1st. They’ve done the same thing for lumbosacral discs.

There’s M5137 lumbosacral discs, meaning L5S1. But you’ll see it’s the same protocol with back pain, with lower extremity pain, or a combination of both. So just making sure no longer now is it just one simple code. But there’s going to be three codes demonstrating when it’s hurting, Or one if there’s asymptomatic.

Now you might think Sam, I don’t know if that’s significant to me. I’m an acupuncturist, but if you think of it, how often do you treat people with chronic back pain that often could be disc related, you may not be making that as the primary code, but if it’s on the claim, we better make sure we have the right code to it.

Now, one thing to keep in mind though, let’s say you’re coding someone with back pain. Just plain back pain. You cannot use a back pain code with the disc code. So never combine like an m51 series like lumbar disc or lumbosacral disc with a pain code. In my opinion, obviously you’re gonna use the disc code.

It’s more severe. I mean think if you said someone has back pain compared to saying discogenic back pain or disc causing leg pain, I think you’ll see the severity levels a little bit higher. Probably longer term care. Bottom line, I want to make clear those. Don’t combine them. If you say, Sam, I don’t want to use a lumbosacral disc code, I would say why not, if it’s already been coded for you.

But if so, make sure not to combine it with the back pain codes. And let’s keep in mind, back pain codes updated. What is that? Four years ago now, however, I wanna make sure it’s clear. The back pain codes are M 54 50 for unspecified low back pain. We have M 54 51 for vertebral genic, low back pain, and then we have M 54 59 for other low back pain.

You might be thinking Sam, that’s not new. Why are you updating it? ’cause this is a problem. I see. Obviously many acupuncturists now are beginning to access particularly Medicare. Part C plans. These are your Medicare Advantage or private pay insurance plans that many will have direct access for acupuncture, not needing an MD.

When you have a plan like that, do not use M5450. Please make sure you’re using M5451. Or, M5459. If you use M5450 for the Medicare plans, you’re going to reject it. So keep in mind M5451 or 59. My opinion, M5459, best choice. Other means something that you can name or the reason for. It could be pregnancy related for that matter.

Bottom line is, no pain codes with DISC. If you’re coding DISC, here’s what I’ll tell you. The association is it’s already there. Now you can see there is a code that says no pain, but In other words, don’t put pain with it, but one or the other. Now, there’s some other codes that are musculoskeletal related.

You might look and go Sam, I don’t know if I’d ever use this. And I’m going to say these aren’t probably common, but I want to make you aware. Because as you can tell with diagnosis, they’re commonly looking to update and make things more granular, more explained, if you will. Currently we have a code that just says, Sinovitis, tenosinovitis.

Unspecified. And that’s basically your tendonitis codes. Here’s what we have now. Codes that are specific for these conditions that are going to each area. Shoulder, arm, forearm, hand. So everything upper extremity. In addition, lower extremity. So you’ll see here thigh, lower leg, ankle and foot, and so on.

The idea is that coding is always there to try to give us our best way of describing what’s going on. At the same token, don’t be afraid to be simple when it comes to acupuncture. Often a pain code is going to be your best bet. However, when I can have something more granular, I like it. Think of disc degeneration with pain compared to just back pain.

I think we see two different things there. But also know what the carrier requires. So by example, if you were billing Aetna, even though they may have a disc issue, You’re going to code it as pain, because that’s what they accept. Cigna Insurance, Anthem. Others will accept the DistriGeneration, so know which plans you’re dealing with.

As always, the American Acupuncture Council is here for your help. I run our network. The network services, we do seminars, and we do one on one help. That’s really what we do. If you want to make an expert part of your team, take a look at our site. Take a look at what we offer. We give you two CE seminars a year, plus unlimited access to get with me.

So we can go over everything in your practice. What are your fees? Are you building the coach properly? How do you document? How do we make sure we’re getting paid? We always want to make sure you have success because your success is ours. Until next time, my friends.

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Approaching Children In the Treatment Room – Cowan and Heller

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