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, my name’s Michelle Gellis, and today I am going to be talking to you about my top 10 facial acupuncture points. I am a licensed board certified acupuncture physician, and I teach cosmetic and facial acupuncture classes internationally. Can you go to the first slide? Great.
So when I’m talking about my top 10 facial acupuncture points, these are both for cosmetic purposes, but some of them have spillover into treating neuromuscular facial conditions as well. So the first point I wanna talk about is and you might be wondering, what does this have to do with facial acupuncture?
When you needle shen men, it helps to calm your patient, which is. great when you’re going to be putting needles in their face, and it also relaxes the face itself when we think about our face and our face aging. We might think it’s a good thing to tighten up the facial muscles, when in reality the facial muscles when they’re tight and constricted, then the skin will wrinkle.
So you really want the face to be relaxed when you’re going to work on the face. So my first favorite facial acupuncture point is ear chan men.
My next favorite point when working on the face is gallbladder 41. And gallbladder 41, although it is on the feet, it helps when you are doing cosmetic and facial acupuncture in a couple of ways. Most importantly is it helps to keep your patient grounded because when you’re bringing a lot of energy up to the face and the neck and the head, you wanna make sure you counter that with some grounding points.
So this is always the first body point I put in when I’m doing cosmetic acupuncture. It also helps to relax the liver and spreads chi throughout the liver and the gall bladder channels. And this will help if your patient is very frustrated or angry because frustration and anger can cause a lot of constriction in the forehead and cause lines between the eyebrows.
My next favorite point when doing cosmetic and facial acupuncture is stomach 36 and stomach 36 is probably my most favorite acupuncture point of all of the points if I had to pick one. And the reason for this is, , it covers so many different things. It’s the chicken soup point for acupuncture, and it helps to infuse all of the gifts of the earth to all of the meridians.
It’s a sea of nourishment point, which is really important when you’re working with the skin. You wanna make certain that all of the. Food and drinks that you take in get digested properly, get into your bloodstream and are spread throughout the body. It also helps to tonify chi and blood, which can become deficient as we get older.
We can get blood deficient and chi deficient and by needling stomach 36, it helps tonify the chim blood. . It also helps to fortify the spleen, which is really important because as we get older and the spleen becomes weaker and not as efficient, we can have sagging. So the spleen holds things up and it also is very much integral with.
Creating nice, healthy blood. So holding things up and making sure that our blood is healthy are two of the spleen’s jobs. So by needling stomach 36, you’re fortifying the spleen and the next. Important thing about Stomach 36, which should have been its own bullet, but it calms the spirit. And when you’re doing cosmetic acupuncture, you want your patient to be nice and calm.
My next favorite facial acupuncture point, which is also on the body, is large intestine four, and this is a command point for the face. So I would never do cosmetic acupuncture without needling large intestine for, and it also allows us to get rid of impurities. Not just on a physical level, but also on a mental level.
So really clearing out all of the impurities on a body mind, and spirit level. I. Next is small Intestine six, and the name for small intestine six is nourishing the old. So if you think about where small Intestine channel runs, it runs right up the neck and then up. In front of the ear and it can help with sagging jowls and chin and neck.
It activates the entire channel because it is a sheet cleft point, and it also helps to nourish us in the face of old pain and allows us to. Taken all of life’s lessons from past traumas and it, it really calls on some of our ancestral chi as well. . Next is gallbladder 18. So gallbladder 18, in case you don’t know where it is.
So you go to the center of the brow, and that’s gallbladder I’m sorry, the center of the frontals muscle and. , which is in the middle of the brow and that’s gallbladder 14. Then you find gallbladder 15 and you’re going to go back along the gallbladder line until you are in alignment with do 20, so where the gallbladder meridian and do 20 intersect on the head.
This is where gallbladder 18 is, and you can see it here. And this is the occipital frontal. So the gallbladder 18 helps to benefit the eyes and the forehead, and it has a direct action on that super orbital nerve. So that’s this right here. and the super orbital nerve, which is C N six runs along the Galea epi erotica, which links the occipital and frontal bellies of the occipital frontalis muscle.
So when you needle that point, it helps to nourish the eyes, lift the brow, and lift. The forehead as well.
Next is stomach four, and the name of this point is receive nourishment. So stomach four is right at the corners of the mouth and it helps to treat the mouth area. Lip lines, naso, labial, folds that. Run right into this area. It’s also right on the Modis, which connects the lader muscles on the face. The depressor, anguli, ORs, the resources muscle, all of these muscles.
Calm together right here at Stomach four. So by needling this point it helps to relax the depressor, angular ORs, which can pull down on the corners of the mouth and Ma make us look unhappy when we are not
Next. Next is small intestine 18 and the name of this point. Is cheekbone and very appropriately named, and this helps to lift the cheek area. The way that I like to needle it is I come over the cheek and then I will needle straight up, so I’ll. Go over the cheek and I like to use tubes when I work on the face.
So I come over the cheek and then I will needle straight up right underneath the bone and this will help to lift up the cheek area.
Next is Yu and I do a combination of points in order to lift the brow and the eyelid. I’ll use Yu and Sano. 23 and Blood are two together, and I have a little video here for how I would needle.
Like really like this. What I’ll do is I’ll pull up, but for her I would just use the tube and push underneath the brow like that. So again, I’m not on the lid, I’m underneath the brow. And you know why they called us you? Yeah. Don’t you? . Ouch. Yeah. You. Yeah.
So you could see in the video, I like to pull the brow up above the orbital rim, and then I will just push the tube underneath the brow and then push the needle straight up. I use a half an inch needle. I usually put a little anika gel there because the orbit is very highly vascularized and you don’t wanna bruise your patient.
and then I will push it in almost up to the handle. And this really helps, works on the lader muscle and helps to treat you. Yeah. And then by using some supplemental points around the brow and the forehead, it really can help to lift this area because one of the biggest concerns that. My patients have had over the years is that their eyelids are starting to get droopy or their brows are getting droopy, like really like my last favorite acupuncture point for.
Facial and cosmetic acupuncture is Yong, and Yong is great for a lot of reasons, and it’s right there between the brows. This helps if your patient has any lines between like wrinkles, deep furrows between their brows. You can use Yong. and it also helps to relax your patient and spread the chi in this area.
It calms the mind. It calms the patient. So this is a great point. I use it on almost everyone, even if they’re not coming to me for facial and cosmetic acupuncture. So there you have it. My top 10 favorite acupuncture points for facial acupuncture, and you can follow me on social media. Michelle Gellis on Facebook, Instagram.
TikTok and on LinkedIn, and I also have a Facebook group called Facial Acupuncture, and my website is facial acupuncture classes.com. I hope you enjoyed this, and thank you to the American Acupuncture Council for providing me with this opportunity to share this with you.
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.
Hello I’m Brian Lau. I, first of all, I’d like to thank American Acupuncture Council for having me back. Today we’re gonna be presenting on some shoulder mobility. We’re gonna look right away from at a shoulder mobility drip drill with weighted clubs. So that’s why I’m standing here. We’re gonna go over some movement aspects with that.
These would be something you can do yourself, which are really great mobilization exercises to keep your own shoulders healthy. But also you could prescribe these to patients. We’ll look at some caveats for when you can do that, when you might not want to do that. It might be a little too much depending on the stage of shoulder injury.
This would also have implications for neck injuries. We can go over some of that in context. Let’s go over that right from the start. But let’s look at some movement aspects first. So I have a little bit of a bone model here. So this would be my left scapula. and left humerus. So I’m gonna put it in front of me.
Obviously this would be behind the ribcage, but just to give a little bit of context. So we’re gonna be looking at this shoulder mobility drill that’s gonna work on the glenohumeral joint, of course. So we have good movement in that, but we’re also challenging the strength so that we can do movement with stability and the joints not moving around excessively.
But with any shoulder movement, we wanna look at this sort of dance between the shoulder joint. and the shoulder girdle. For instance, you can look up something called the scapula humeral rhythm. So with that’s specifically in reference to abduction. As the body goes into abduction, as the arm goes into abduction, you wanna have this following of the scapula.
So it goes into upward rotation. The scapula’s not moving real well. It’s very possible, probable that the joint will hit the head of the humerus up against the acromion, and that can pinch and compress and impinge on the superspinatus tendon, biceps tendon. A lot of tendon type impingement problems can come from that.
So it’s a nice dance. You can look at it up online. You can find the exact ratio of movement of how they relate to each other. But it’s not just abduction. When the body does internal rotation in the shoulder joint, the scapula likes to follow into protraction. So it gives a little bit of room, a little bit of movement.
So that the joint doesn’t get compressed in the front of the joint. Same thing with external rotation. Sometimes it likes to combine itself with retraction of the scapula. Maybe even a little bit of a downward pull on the scapula. So there’s a nice dance of movement between the scapula on the ribcage glenohumeral joint.
I could add to that. the sternoclavicular joint so that this whole complex is moving in this nice unified movement. It’s not just the shoulder girdle though. When I’m doing any type of movement like overhead, my ribcage is gonna open and expand and move. So there’s a combined movement that happens in the ribcage all the way down to the diaphragm so that a lot of these movements take this whole range of motion of the upper body, thoracic spine ribcage.
Shoulder blade, sternoclavicular, joint glenohumeral joint, and a combined activity that’s organized and controlled, or at least we want it to be organized and controlled. There’s a lot of neurology that helps link that. The phrenic nerve going down to the diaphragm has a lot of relationships to the shoulder joint.
In the shoulder capsule, but also the rotator cuff muscles. If I go on the right side, there’s a little branch of the fren phrenic nerve called the nicco abdominal nerve that goes right into the liver into the capsule of the liver. So any liver mobility problems are also gonna potentially show up as especially right shoulder problems.
So that’s a lot to think about. We’re going to. Not necessarily try to dwell on all of those. As we’re doing the movement, we’re gonna look at one key aspect and allow all of those other things to happen. So I’m gonna put this down for a second and grab another tool.
So we’re gonna have a weighted club. If you don’t have a club, that’s fine. I’ll show you what you can do without one. It’s actually nice to start without a club. This is a five pound club. One or two pounds is really nice to start with. Or we can just have our thumb out. , my arm has a certain amount of weight in it, so this is fine.
All the movements we can do to get used to these movements, we can get we can do without a club or you can have a wooden spoon or something if you wanna have a little bit of something that gives you an idea of where you are in space. That’s one nice thing of the club. But the actual weight is useful too.
So if you were to do this on an ongoing basis, maybe start with a two pound weight, three pound weight, and you can go up from there. We’ll look at some options. So we’re gonna be holding the club at the base. I’m gonna have my arm out at 90 degrees in elbow flexion. I’m gonna start at about level with the opposite shoulder, so I’m in a little bit of internal rotation.
My chest can be relaxed. Again, if you don’t have a club, you can just stick your thumb up and that’ll give you an idea of the direction that you have. So the first thing I wanna do is just warm up the joint. We’re gonna build a movement here, piece by piece. So I’m gonna go into external and pull the shoulder blade back.
So I should get my arm lined up to the side, my elbow’s level with my hand. Chest is open. Then back into internal rotation. I can let my chest fold just a little bit. So right from the get-go, the driving force is the shoulder blade. I wanna pull my shoulder blade open, or I should say pull it back towards the spine to open the front.
Then I wanna let the shoulder blade come into protraction, my chest relaxes retraction, pull the shoulder blade towards the spine, open the chest. So right from the start, we’re working on the hearts in you channel as I go into internal rotation and the small intestines in you channel. As I go into external rotation and pull the shoulder blade, it’s fine.
So nice exercise for the in you channels. Alright, so this is stage one, but we’re going add a swing to this. So instead of me just turning my arm out, I’m gonna let the weight drop and find that position again. Let the weight drop swing. So it’s a swing and a catch. Down, turn the arm, open the chest, catch down, turn the arm, close the chest.
Catch. So swing you can go slow or you can start speeding it up if you feel comfortable with it. So we’re building a movement. This is a movement called Mills. Okay, next thing, swing. Catch now I’m gonna go overhead. I want my shoulder blade to be the driving force, so I want my shoulder blade to go into upward rotation, hand behind the neck, down, catch up,
down, up. I wanna keep a stable base down. Okay, now we’ll change one more time. Up
turn, throw, catch, swing, catch, cast it, overhead, turn, throw catch. So that’s the movement. It’s like a throwing motion like you’re throwing a baseball, but again, driven by the shoulder blade. Pull the shoulder blade back to open the chest. Upwardly rotate to point your scapula up towards the sky, protract and down.
Very nice. We can go the other way now. So over the shoulder, same shoulder. Pull the shoulder blade, open down, swing catch. Cast open, throw, swing, catch, cast open. Throw one more time. Swing and catch. Cast open. Pull the shoulder, blade back, throw. All right. Real quick, we’ll do it on the other side. Then we’ll look at some various options, when to do this, how to do it with patients or for yourself if you’re having shoulder issues.
So let’s go quickly through it again. Internal external rotation, external pull the shoulder blade open, chest opens, line the elbow up with the hand. So I don’t want my elbow facing back. I want it under level with the hand, chest in,
open the chest. Okay, we can do that with a swing. Let the weight drop up. Drop up 90 degrees. Drop up again, we’ll go overhead now. So up. Hide the hand behind the neck. Throw catch up. Throw catch. Okay, one more change up. I wanna turn my body in front of the other shoulder, swing, catch, cast, throw, swing, catch, cast, throw either direction over same shoulder.
Pull the shoulder blade open to pull the chest open down
over the shoulder. Retract the scapula, pull the chest open down.
So great movement to strengthen the shoulder blade the shoulder joint to strengthen and move the shoulder blade and to coordinate that activity with the chest and ribcage. This would be not a good idea to start with the five pound of somebody who’s having shoulder pain. Maybe that’s where it’s really nice to start with just the weight of the arm.
Maybe they have a painful arc. Oh, that’s causing a lot of sharp pain just to do that. They’re not stable. They don’t have strength to support that shoulder shoulder joint. They don’t have the strength for that shoulder blade to roll up and upward rotation so that they have a comfortable, nice movement and oh, it hurts to do that.
It’s probably not a good exercise for them. You need to build them up to that. You need to give them a simpler exercise, a floor exercise. We’ll look at some acupuncture techniques. There’s a lot that has to happen before they can comfortably do this. Once they can comfortably go up, maybe starting with no weight, one pound, two pounds would be a good idea.
Keep it small. Once they get coordinated movement then, and they’re feeling comfortable with that. Five pound,
five pounds pretty good. They get a little more comfortable, then they can go up more weight. So adding weight will create a little bit more challenge. So this is 10 pounds. So if I’m doing the same movement with this 10 pound weight, then that requires more force, obviously, but it’s not just the weight.
So 10 pounds
and 10 pounds. Now this 10 pounds weighs a lot more than the other 10 pounds because of where that weight is sitting farther away from my hand. And the torque that creates. when I’m going ahead, I don’t wanna swing it cuz my camera’s pretty close here, . But when I’m going ahead and if I were to swing that through, that’s gonna require a lot more strength on my part to be able to balance and manipulate this weight that’s farther from my hand if I were to move down even to the handle.
Even just holding that and stabilizing it is a lot more difficult because, oh, any little movement here, I have to do a lot more stability to support that. Since it’s so much farther away from my hand. So those are ways you can increase and build on this exercise. But you don’t wanna start with a shoulder.
A patient with shoulder pain, painful arc with that mace. You may not even be able to start with the weight of their own arm. You have to build them up to it. So just some ideas, some things you can work with go through step by step, maybe starting. with that, just internal external rotation, if that’s not excessively painful, just to be able to balance that weight in external rotation is gonna start to strengthen and stabilize that joint.
So that would be a good starting place. Then you can build until they get the full sort of movement of throwing. So that’s what I wanted to start off with was the mobilization. So we can start thinking about feeling, coordinating that activity of the shoulder blades with the movement of the glenohumeral joint and how that relates to the chest and all of the whole, really the whole body.
So what if they have limited range of motion? Let’s go over some potential techniques. We’re gonna focus mostly on the pectoralis major, cuz the pectoralis major has to lengthen to be able to get my arm back. It has to lengthen to be able to get my arm back in both positions, different fibers. But Peck major is gonna be one of the key structures that’s gonna limit mobility.
If this peck major’s held in a shortened position, I can only go so far. So I want to be able to have full range of motion, full elong full ability to elongate in that pack. Major in all different planes. So we’ll focus on that. I’ll tell you from the get-go, Sarus anterior would be another big one.
Another day we’ll just focus on P Major for today. So I’m gonna switch to PowerPoint and let’s go over a little bit of information, a little bit of the anatomy, and we can look at some techniques for acupuncture and manual therapy. So let’s get the slides up. I’m gonna come a little closer.
All right. All right. So here’s some netter images. If we look at the left image first, let’s look at the bottom left. We have Peck major. So Peck major’s a really intriguing muscle. It has the clavicular head that’s going up and attaching to the medial third of the clavicle. It has the sternal head attaching to the sternum.
Then as we go down a little bit, we see costal fibers attaching to the costal cartilage and that bottommost slip that you see attaching into the abdominal fascia. Is the abdominal head. So we have really four heads depending on how it’s divided. Some books look at it as three heads, but clavicular, sternal, costal and abdominal heads are the way I look at it.
So interesting thing about that is they play out with the yin channels of the arm. The clavicular head is part of the sinu channel, sternal head, part of the heart, Sinu channel Costal, and an abdominal head, part of the pericardium Sinu channel. Those fibers have to organize themselves with the muscles of the back, such as the rhomboids.
So we’re looking at the sternal fibers and we were going into that external rotation movement with the arm down. Peck major has to elongate, rhomboids pulls the shoulder blade back towards the spine. So it’s a balance between the hearts in you channel and the small intestines in you channel. , we start from internal rotation, Peck major’s in a shortened position as it goes into external rotation.
Infraspinatus, Terry’s minor part of the small intestine sy channeler firing while the peck major is lengthening. So they have this yin young relationship of one letting go, one shortening. So we don’t have time to go through all the channel relationships for each of them, but that’s one to start with.
We’ll look a few at a few of them though as we go into the PowerPoint. So lung sinu, channel clavicular, head of the Peck majors, part of that Peck miner’s, really the key muscle that’s also involved with this shoulder mobility exercise we were doing. Peck miner is gonna have a tendency to pull that shoulder forward into an anterior tilt when it’s shortened.
If you remembered from that exercise we were doing, we had a pretty neutral. Position the scapula is moving a lot, but we didn’t have this jutted out forward shoulder at any point when we were doing it. If that’s in a shortened position like that, we need to do a technique acupuncture’s great to be able to release the peck miner.
We can also use points along the channel, even muscles along the channel, like the flexor carpi. Radialis is a really great muscle to release the peck miner, so needling the motor point. If you’ve studied with sports medicine, acupuncture, we teach the motor point for flexor carpi radialis. Fantastic distal point, even though it’s not an official lung channel point, it’s kind of part of the lung inu channel.
So really a fantastic point to release Peck miner. But Peck miner needling is something to learn too with the caveat of being safe with it because it is close to the PLE cavity. That Peck miner is gonna have to be balanced by the large intestines Inu channel, lower traps, which is supporting it.
Those have that yin yang balance. Also upper fibers of Sarus anterior part of the long Sinu channel. Those are those upper two slips. They have a different fiber direction than the rest of the sarus anterior, and they have different action. Again, we can come back to Sarus anterior maybe another day. So here’s the movement of the lung sinu channel.
It’s gonna tend to pull that scapula, like that top arrow, which is pulling the scapula down into an anterior tilt, countered by the large intestines Sinu channel, which stabilizes the scapula against that force of the peck miner. So if you go back and review large intestine Sinu channel, you’ll see that it goes down into the thoracic spine.
It follows those lower trap fibers. So nice combination to work with. Har Sinu channel was the one we alluded to just before. The Har Sinu channel includes pretty much the Peck major, I think of the whole Peck major, but really the sternal head in particular is the big one for Hart Sinu channel.
This would be very important for that movement that we were doing, the mills that we were doing with the weighted clubs. We can also notice that the subscapularis is in there. Subscapularis is another big one, a really great muscle to learn how to needle. But it’s not something for a webinar.
That one’s much better for classroom setting because you’re going. Deep into heart. One with really a three inch needle, you have to be very mindful of where the ribcage is, so you can advance the needle towards subscapularis, but not towards the ribcage. So plenty of space if you do it properly. But too much room for error on a webinar.
So classroom setting. Another day we will look at some needling for tech major, though. So this relationship for the scapula is, again, we have protraction As the scapula pulls around, the ribcage moves away from the spine. P major is one of the big muscles that’s gonna contribute to that. And then that’s countered by the rhomboids, which are multiple channels.
But in this case, they’re acting along with other muscles as part of the small intestine sy you channel. But all of that’s happening with internal rotation, pag, external rotation, infraspinatus, Terry’s minor, also subscapularis, part of the small intestines in new channel. So those have to coordinate their activity as one shortens.
The other one has to let go as the, then it changes phases, and the other one shortens. They have to alternate. Elongate contract. Elongate contract. So very much of a yin yang relationship with those two. Peck major is usually the one that’s overactive, and we’ll be looking at a technique for that. Finally, the Pericardium Sinu channel.
Pericardium Sinu channel has a really interesting trajectory. . It involves the sarus anterior, also these lower fibers of the Peck major, all of those come down and blend in with this abdominal fascia. So it creates like a almost like a fascial belt around the ribcage that can get too tight. So we need to loosen up that belt.
Nice thing about that exercise we were doing is we had that in. an out aspect with the chest. So we’re starting to exercise and soften that sort of what can be a too tight of a belt around the ribcage for a lot of people. So the interesting thing about this one though is it wraps around the ribcage, which it’s discussed classically, but I take it a little beyond what you might think and into this Rambos sling.
So the sarus anterior attaches to the medial border of the scapula, and it links seamlessly with the sarus anterior. So much so that in recent dissection, and I’ve done this a few times, you can tease the fibers of the rhomboids and sarus anterior off the scapula and kind of layer, soft, slow approach and then bring the scapula away and you just have this seamless.
Sling of tissue that you don’t see really a break. All is where the scapula attached to it. But you have the sarus, anterior rhomboids is one continuous structure. You can pull the scapula off. It’s not something that if you were to take the scap off, you’d have to sew those back together.
They’re already united. They’re already part of a sling. That actually then combines over to the contralateral side and blends in with the SIA services and capitus. So this shoulder movement that we’re doing can have good implications for neck pain for a lot of reasons, but one of which is that those snia services and capitus muscles become problematic for a lot of neck pain patterns.
So we can needle splenius services, we can needle splenius capitus of their pain producers, but to be able to integrate them with the scapular movement so that there’s this nice sling expansion contraction on either side is a really great way to keep those changes. So this exercise we’re looking at, fantastic for shoulder problems, but neck problems, especially with plem and surfaces pain patterns, right?
So movement pattern with those and things you can look at. Somewhat protraction and retraction, but also that upward and downward rotation of the scapula. PS radius anterior in particular upwardly, rotates the scapula. So if you go back to this movement we were doing, there’s a lot of times where the scap is doing this circular movement of rotating up around ProTrac, protraction, rotating back down, rotating up.
Retraction rotating down. So that rotational aspect of the scapula is a very key movement of the pericardium sinu channel, moderated by the lower fibers of the peck, major sarus anterior, and then the rhomboids and also the upper part of the traps. So I put this pericardium Sinu channel in here, but again, this is an ebb and flow between Pericardium Sinu channel, San Joo channel.
So lots of scapular movement, lots of things to think about with just a small exercise. You’re really working all three of those in you channels. But I think the big one is pericardium and San Joo channel. That’s the one that’s the most prominent with the exercise we looked at. Got to twist my arm to say that cuz the other ones are.
All right, so tech major is what we’re focusing on for treatment. So you’re teaching this exercise to somebody or you’re doing it yourself. And oh, it’s hard to really get that arm back. It’s hard to pull that shoulder back and have this nice open chest because of that Peck major holding everything. So it’s like this too tight of a grip on the shoulder blade, and I can’t get that movement.
Or when I’m back here, I can’t get my arm back because that Peck major is pulling. So any of those positions that are difficult to get. Open in the chest. Peck major is gonna be a key player in that, and it’s one that we can look at on the webinar. There’s some concerns. We have to be careful. We have to know where the ribcage is.
There’s some cautions. I put this in the video and this is a video that’s up on my YouTube channel. You can reference later, or you can reference it directly from this webinar, which will be recorded. But it’s safe enough. I think we can look at it. In a webinar setting, I go through step by step.
This is a way to needle the Peck major for those who have taken sports medicine, acupuncture classes. Matt teaches it a little bit differently, which I think is great and maybe good for a class setting. I felt a little more comfortable with this one for a webinar setting because we’re holding the tissue up away from the ribcage.
So it’s it’s one that I use. I like it. Just for the reason that I like the technique, but it’s also, I think, a really useful one to have on the YouTube channel. And have on the webinar because I mitigates the risks by lifting the tissue away. So let’s look at it.
Okay.
We’re gonna look at palpation for to bands within the pectoralis major muscle, and we’ll look at a way of needling this muscle safely. First, let’s identify the fiber direction for the various portions of this muscle. The CLA head runs from the medial of the clavicle to the specifically the lateral lip of the, okay.
The sternal head runs from the sternum to the universe.
And the coastal and abdominal heads run from the coastal cartilage and the abdominal fascia, and then travel up to the s.
The arm down the clavicular fibers run superficial to the sternal fibers.
Which runs superficial to the coastal and abdominal fibers. The layered arrangement changes when the arm is overhead. The different layers unwrap and then wrap again as the arm is brought down. Palpating for top bands and the muscle can be helpful to gauge tension. Here I am palpating the clavicular head.
In assessing pretension, I can also push from inferior to superior or superior to inferior to feel which offers the most resistant.
And I can advance the needle across the fibers in that direction.
I have to take care that I place the needle in the same angle as the palpation and not change the angle deeper towards the.
Now I am palpating sternal head, starting from the sternum, and noting a local twitch with palpation.
This layer has a notable, palpable band, an easy way to needle the factor. Major is to grasp and lift the tissue away from the underlying rib cage
while grasping. You should feel the plane, the rib cage makes.
You then find the top band and place your two fingers around it.
Place the guide tube at an angle that allows the needle to penetrate the band and then advance the needle into the P major. Direct it toward your thumb into the needle, parallel to the rootage.
You can redirect the needle, but keep the needle parallel to the ribcage until you get the needle response.
The needle is always directed parallel to the ribcage, and you should never aim the needle towards the ribcage. The needle is parallel to the ribcage directed slowly towards the thumb and not downward towards the feral cap.
You should not perform this technique if you do not have an adequate sense of where the ribcage is the plaintiff makes, or where the needle tip is in relationship to your thumb. The advancing needle can be felt by the thumb, but you need to be sensitive to this. You should not perform this technique on women with breast implants.
Otherwise, working with women is essentially the same. Palpation will be the same, but you’ll not be palpating through breast tissue. You still have access to muscle around the breast tissue. Let’s go over this technique again on a female model, . So when I’m palpating, I want to feel for the clavicular fibers.
I can press into fibers going up. and that inferior to superior direction, or I can palpate into them from a superior to inferior direction. Feeling for resistance doesn’t feel particularly top. So I’m not gonna needle those fibers. I can palpate close to the stern looking for top bands.
Of one right there through that sternal fiber. Sometimes you’ll even see a local twitch response as you palpate through that. Interestingly, I can see a little bit of that local Twitch response respond up through the s SCM muscles. Those pec fibers do link with the scm, but I just feel able to top in there.
If I were to follow that’s gonna take me into that sternal portion of the muscle and. That’ll help me find and differentiate where there’s spot in the muscle for men. You have a little bit more territory you can palpate for women this sternal edge is a really useful area cause you can palpate feel without having even the ship.
The other area where you can palpate where it’s probably easiest to needle is that the excellent. So I have access to the bulk of the muscle through here. This is where knowing those fiber orientations can be very helpful. So I can come and feel for hotness within the muscle. Noticeable damage fibers.
And this is the easiest way to needle it. If you wanna be very cautious. I wouldn’t do this needle technique, breast implants cause you could puncture the breast implant, but faring that it’s not a problem. So I can grasp the muscle this way, heal the tension within the muscle hold. To guide you between my fingers, I’m gonna angle towards my thumb.
I can feel the edge of the top end, and maybe looking for trigger points you might need get a switch response with palpation, and I can hold and then advance the needle towards my thumb. I need to be really comfortable with the idea of kneeling towards my numb feeling that needle advance towards my thumb, bring it out, but it’s very safe situation there.
Do some general looking thrusting, different needle angles to listener response to tech nature.
All right, so I have a minute long myofascial release. This was longer technique, but this was YouTube short. This is on the Sports Medicine acupuncture YouTube channel. So you can reference it there. Again, it’ll be in the recording. This will be the last thing we have for today. And you can see a follow up technique to the needling.
Myofascial release for the HE major will take place with either the patient having their arm down by the side, especially useful for the clavicular head attachments, or having the arm up above the head and external rotation. Much better for the sternal and the costal fibers. And what you’re gonna have the patient do is start to turn their torso, start turning towards your same side.
So you wanna have the fibers shorten so that you can get in, get a good investment, get a good grab of the tissue, and relax there. Then have them turn away from the shoulder so they’re keeping the shoulder on the table. And trying a little slower, one slower turn the torso away, and they’re having to learn how to relax that als nature while you’re spreading through it.
All right. Very nice. Feel free to check these videos out. Like I said, those, the references along with this recording will be on the on my channel. It’ll be in multiple places, but it’ll be on my YouTube channel. The QR code is there, but also the webpage along with sports medicine, acupuncture had that myofascial release technique.
So I think I can take off the slides. And just to give a quick idea with that myofascial technique, in that exercise we were doing, we were moving the shoulder away from the ribcage. to get more space and buy that the front of the rib cage, I should say. So that ability for Peck major to move kinda like I’m throwing a ball, I have to be able to expand and move that shoulder away.
The myofascial technique, we did it slightly different, is we compressed and moved the rib, moved the sternum closer to the humerus and had the patient relax the shoulder on the table while they moved the sternum away from the arm. So same thing. The just different reference point is they were learning how to relax the Peck major so that they could turn the sternum away from the arm.
And in the exercise they were. Moving the arm away from the sternum. So same idea, just a different focus. Both of those are gonna require the peck major to lengthen. Both of those are gonna open the heart a little bit, or at least the heart channel, heart send you channel. Great exercise. If you have any questions feel free to comment on the webinar.
I’ll be checking those and maybe it’s something you can add to your routine, definitely with patience, but even yourself. I think that mobility exercise is a really fantastic exercise. So thanks again for American Acupuncture Council for having me. Dr. Martha Lucas will be here next week, so check check out next week and I will see you guys again another time.
And we’re gonna talk a little bit about reimbursements today in the sense of, let’s talk about the acupuncture scope of practice and more specifically therapies.
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 everyone. We’re back for another episode. Thank you for being with me. This is Sam Collins, your coding and billing expert for the American Acupuncture Council, specifically the network, your compliance, billing, coding, and most importantly, reimbursement expert. And we’re gonna talk a little bit about reimbursements today in the sense of, let’s talk about the acupuncture scope of practice and more specifically therapies.
Many of you are doing therapies, and I’m not saying you have to do therapies, but many of you do, and for the most part they are reimbursable. We wanna make sure when they are reimbursed that we don’t have any issues with that it wasn’t documented properly. Or some of these things some of you run into when you get denials because they look at your notes and go, wait, it wasn’t there.
I wanna make sure you know the quick and easy of how to do it, not complicated and whether or not who may provide them. As you’re familiar with physical therapists, chiropractors can use assistance. But can an acupuncturist. So let’s go to the slides. Let’s talk about what is the scope of practice for acupuncture.
So let’s look at the acupuncture scope of practice and look at what’s going on for us, what’s allowed, who may perform it, and all those things. I mentioned now generically, the scope of practice. Is one that it generally states this type of issue here, and I’ve just given an example. It means the stimulation of certain points or points on the surface of the body by the insertion of needles.
So in other words, inserting needles. That’s acupuncture. But beyond the acupuncture, of course, what else can you do for therapy? So you’ll see here it talks about, Generically perform the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold magnets, nutrition, diet, nerves. In other words, much more than just.
Inserting needles. Now, this specifically is the California rule. Let’s look at another one here. Let’s take a look at Massachusetts, cuz sometimes these rules are somewhat vague or very specific. I’m gonna say, please know your state regulations because some states have more generous allowance, some have less.
So here’s Massachusetts. It talks about adjunctive therapy, so that means things beyond the acupuncture. But notice what it says shall include. But not be limited to. And whenever you say it shall include, it means these things. But of course, more. And I would say pretty much everything you learn or are taught in a standard acupuncture curriculum.
So this is gonna include lots of things in therapies, but also things like what they stayed here for Massachusetts, nutritional counseling, herbology. Recommendation of breathing techniques and exercises and lifestyle, behavioral supportive and educational, and even stress counseling. I wanna focus in on are those things billable?
That gives a pretty broad notion of could they do massage? Sure. That would be something that would be a. Not limited to. Then we’ve got someplace like Florida, which really lays out a ton of things, and I bolded it here. Notice Florida says manual stimulation, accument even goes so far to talk about massage, acupressure, shsu, even tuna.
Electric stem laser, and then even goes into the details of what type of Oriental massage you may have notice here it talks about acupressure, amma ammo, gua rah, reiki, and so forth. Again, given the details, so again, you can see this is a very broad scope. They can do many things. However, let’s take a look at New York.
Some states are more restrictive. It says, the profession of acupuncture is treating by means of mechanical, thermal, or electrical stimulation affected by the insertions of needles or by the application of heat pressure or stimulation at a point or combination of points on the surface of the body. Now you notice here the much more restriction, it doesn’t give adjunctive therapies.
It specifically says heat pressure and electric stem. It doesn’t talk about exercise. Massage or manual therapy. So you wanna be a little bit more careful now as restricted as you will as New York can be. New Jersey across the border, it’s gonna have the most generous, I’m just pointing out, please know what you can provide within your scope.
I’m gonna take the generic standpoint of, for the most part, acupuncturists can perform standard physical medicine services, physical therapy, and so that’s gonna be this listing here. If you’ve ever attended a seminar with me, you’ve seen this type of list where I give you the common C P T codes. You’ll notice that we include acupuncture, of course.
That’s something you can do by nature. Can an acupuncturist all do also do needling? Oh, of course, if you’d like to. Never the same time, but you could. I would recommend acupuncture, of course, but it includes also doing modalities such as heat or electric stem, but also constant attendance ones. What about electric stem?
That’s manual. How about even laser? Notice there’s two different codes for laser. And then of course we have the other things like exercise, massage, manual therapy, even therapeutic activities. And a lot of these, sometimes people are going what do these all mean? What are they? And so I like to think of it, not so much as trying to reinvent and trying to teach you something new, but let’s talk about the things that are commonly done in an acupuncture practice.
What are common therapies? Of course, heat, I would say majority of acupunctures I’ve ever met use some form of heat, whether it’s infrared. TVP lamp. I’ve seen hot stones, hot packs, but heat almost always in scene within scope everywhere, but would also include things like electric stem. Now, I’m not talking electric stem of the acupuncture.
I’m talking electric stem generically, like on the surface, like a TENS unit or the little pads people apply. That’s not uncommon. But it also includes all types of body work, meaning massage or manual therapy or just soft tissue manipulation. I put it generically, this could include twink. Even Gua to an extent, we have to look at word of those fit, but it also includes, and this is something that I think acupuncturists often forget, the active therapies like exercise.
These three codes are in fact covered under the VA program, which are gonna be just standard exercise, therapeutic activities, more functional, and then even balance or coordination training with neuromuscular education. I’m gonna say these are probably the four or five things that are pretty common now with, on that, I would say also cupping in moxa.
Outside of the va, though, we don’t find commonly cupping and moxa will be paid, though I’m not saying not to do it, not to bill a patient. And or the insurance. What I can only guarantee is it’s payment under the va. But nonetheless, these are the common ones. Now, you might say Sam, I’m doing a few more.
That’s okay. If it’s within scope, I’m all in, but I wanna talk about the common things to make sure, are we documenting it properly? So let’s talk modalities, things that you can apply to a patient. But you don’t have to be there. Like you can turn on an infrared heat lamp or a TDP lamp. Let the patient relax, let that heat do its work, but you don’t have to stand there while they’re doing it.
So we say those are unattended, which means there’s no time. So you either do it or you don’t, and you bill accordingly. But we still have to make sure how we’re documenting. And the same would apply. What if you’re doing a modality that is timed? So what does documentation need? Infrared heat. It’s as simple as saying you applied infrared heat to the lumbar spine or whatever, the body region.
Now you’ll notice here I put 15 minutes. Is 15 minutes required? No, because it’s a modality that’s unattended. I’m putting 15 minutes so that I know in my notes how much did I do last time. What I’m pointing out though is that the time that you do it is not going to change how much you can bill. It’s one unit only.
Nonetheless, the key factor here is indicating where I had a provider. And this is with United and a few others that got denied for infrared heat because when they reviewed their notes, it didn’t indicate where. Now the provider said Sam, I was diagnosing the patient’s low back, so obviously the heat had to go to the low back.
I don’t think that’s an illogical explanation, but it doesn’t fly. Always make sure to simply tell me what type of heat where’d you do it. In addition, what if you are doing electric stem? Tell me what type are you doing? Two pads, four pads. What’s the intensity? In fact, the easiest way to think of this should be documented in a way that any person reading it would know how to apply it.
If I told someone, put a hot lamp on their low back for 15 minutes, would you be able to repeat that? I don’t think too much trouble or if I said electric stim in this manner. So think of documenting as just a way of highlighting what you’ve done, not by checking a box. Checking a box that says I did heat would not be sufficient because where did I do it?
What type of heat and so forth. And that even gets more confusing when you look at some of the hands on stuff like massage versus manual therapy. What is the difference? They’re very similar. Generally manual therapy is more focal, I’m going to say probably I. Deep tissue, if you will, that’s focused on a trigger point is probably gonna fit more manual therapy, whereas the more generic stroking and relaxation would be massage.
The key factor is document what you’re doing with either one to differentiate between the two. So tell me what type of massage you’re doing, or trigger point or myofascial release. Lots of ways of describing it. Tell me how much time you spent, because this is a time code now you can put start and stop times.
You can say I started at 11, ended at 1135. Or you can say I did 35 minutes. Either way is acceptable, but it is absolutely required that you put how much time, like acupuncture, you have to have the time element. So simply document what you’re doing in a way that when someone looks at it, they can see what was done.
And then of course, always have a little bit of, why’d I do it? What was my purpose? What was the outcome or the goals? Give a little bit of how the patient felt after the visit. Did it accomplish what you’re looking for? Even exercise acupuncturist, if you think of probably, The most ancient form, if you will, probably stems back to acupuncture.
When you think of Chiang Tai Chi and those types, the enhancement of the physical culture of the body. Now, that doesn’t mean you’re turning your office into Gold’s Gym, but what if you are doing some exercises or you’re putting the patient through a series of stretches or other types of exercise, yoga.
Otherwise, absolutely. Just tell me what you’re doing. How many sets, how many reps, or whatever the amount of time that you’re spending. The key factor is when you’re documenting anything that’s time. Do remember the eight minute rule. This is the same. That’s true for of course, acupuncture. Remember, one unit can be as little as eight minutes.
That’s perfectly fine for one unit, but to get to two units, it has to equal 23. So let’s say by example, you did 10 minutes face to face for acupuncture and 10 minutes of exercise. Would that be acceptable to bill two units, meaning one of each? The answer is actually no, because if you think of it, if I did 10 minutes and 10 minutes, what’s the total number of minutes?
Only 20. Therefore, that’s not enough for two units. Notice two units takes 23, so it’s 15, if you will, plus eight to the next, so you gotta make sure it adds up. Now, by contrast, if you did 11 minutes of acupuncture face-to-face, and then 12 minutes of exercise. That actually would count. It’s that specific.
Tell me the time. Generally, when you write the time down and you really put from, and two, you’re gonna find, you probably have spent more time than you realized. If you just simply wrote, you spent 15 minutes, you may or may not have spent 15 minutes, often spent more. Keep in mind, look here on what is acceptable for documenting time, though don’t make this hard.
There’s two ways to do it. Tell me how many minutes I’m right here. Or just tell me from, and two, from nine 30 to 9 45. I’m okay with either, but get it in there. What’s unacceptable notice are the generic things like just putting down that I did a unit or telling me that I did an average time. I saw someone said I spent 25 to 35 minutes.
Huh? Either you spent 25 or some number up to 35, but not between that. So just be specific and then please don’t fall to where you just say, I did two sets or two units. It’s gotta be time. That’s not very hard at all. In fact, I think if we were taught that initially in school, probably be a lot easier for many of you.
But just think along those ways. Tell me how much time you spent. I am invariably fine when I help to audit and deal with these types of issues when I talk to the doctor. It turns out they often spend a lot more time than they’ve documented simply because they try to average. It’s what I call, if you tell someone, oh yeah, it takes five minutes to get there.
Does it ever actually take five minutes? Maybe not. That’s the idea. Once you get on the freeway, tell me how much real time it takes, and then let’s follow with, can I use an assistant to perform these? Now as an acupuncture, can you do these clearly part of scope, part of the services.
In fact, the VA encourages it, but may you use an assistant. The answer is no. There’s no laws that create acupuncture assistance in the way that can do therapies under your supervision, meaning that you bill for it. If you are billing for it, you have to provide it. Now by chance, if you had another acupuncturist working for you that did it, then I would say yes, but not someone that’s not licensed under you, if you will.
So keep in mind, we’re not there yet. I’m hearing rumors of some states and I’m hearing maybe Arizona’s gonna be the first one, but as of now, you would need to do all the services that you bill for. You cannot have. A staff person. Now, I know there’s some states that allow people to pull needles, things of that nature.
But again, keep in mind as far as the therapy, no assistance. Now, I’m hoping we get a change there. Obviously chiropractors use them, physical therapists use them. I would think acupuncture should also, but until we have the law, I’m going to say no. Let’s not make this hard. The main thing you do is acupuncture, but there may be therapies that are adjunctive.
Make sure they’re in your scope of practice. Make sure they’re documented. And your dog on you’re gonna bill for it. That is money you deserve and should be paid if you’re not billing for it. If someone’s willing to pay you an extra 50, but you don’t bill for it, they’re not gonna pay it. That’s what I do for you, is to make sure that we can help you get paid.
That’s why we do these programs. It’s what we’re doing for you. If you want some real day-to-day help some that can really make sure you understand what fees should I have, how do I document it properly? Can you help me office, Sam, make sure it’s okay. My job is to always make sure that you honestly just have a better business.
Meaning one that is compliant, but one that also makes sure that you’re getting maximum reimbursement. Give us a look at our website. Otherwise, I’m gonna say it all you. Thanks for being with me. I’ll see you next time. And until then, continue to take good care of your patients.
The diagnosis of infertility or being infertile is very damning for people. It’s scary. It’s like the doctor says, you’re infertile so well, what do I, what am I even trying for?
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, this is Dr. Martha Lucas here with you today. I am a research psychologist and practitioner of Chinese medicine in Denver and Littleton Colorado. In Littleton, I work in a western medicine clinic so that’s a cool way for Chinese medicine to be integrated with Western medicine. Also, in my private practice, I treat mainly internal medicine. My specialty is the diagnosis but I also teach Chinese medicine topics including Mei Zen cosmetic acupuncture, pulse diagnosis and balancing, and a number of other practice building topics.
Let’s go to the slides. You may notice that I say fertility, I don’t say infertility. I call it a fertility challenge. It means that you as the patient have some issues with fertility, with conceiving. The diagnosis of infertility or being infertile is very damning for people. It’s scary; when a doctor says you’re infertile, you’re never going to have a baby, why would you even keep trying. When we call it a fertility challenge, we know that we are working on a goal that may actually happen, rather than just saying you are infertile.
Parenthood is one of the most desired and valued goals of adulthood. Issues with fertility is a very common diagnosis. That’s why we have so many fertility clinics or I guess some call them infertility clinics. Parenthood is a very much desired goal for women and men.
Fear, is an expectation of negative outcomes right? And fear can be constructed from a very complex interplay of different factors – cultural, psychological, social, physical – and this fear actually has a name. It is called Fear of Infertility. It impacts us globally, it is not something that is just in the United States. Basically, it is the fear of inability to achieve pregnancy or father a child.
Some Fear of Infertility is born out of misinformation. And as you can guess, there is a lot of misinformation out there. Years ago, a book called Everything you need to know when you are pregnant came out and I told my patients not to read it. I told them that it’s a natural process to be pregnant, just go with it. For one thing, you are coming for treatment. We will keep good track of it. I actually had a pregnant young lady come in once, who told me that she was a nervous wreck all night because she had slept on her left side for a while and she had read in some book that if you sleep on your left side when you’re pregnant, the fetus is not going to get any blood flow. Naturally, I told her to stop reading that book. Pregnancy is a natural process. You are coming to see me, you are getting medical care, everything is fine.
Some of this misinformation includes things like that though. Some say that the oral contraceptive pills stay in the womb and accumulate. Some of the information is very crazy sounding but it is something that women hear and sometimes believe. Some people believe that birth control blocked their ability to get pregnant and makes them infertile. There is the idea that the HPV vaccine is something that will make you infertile. Or just the idea that if you use any kind of contraception, your womb is going to get weak.
So all of these fears and misinformation can impact behavior. For example, people may not do family planning anymore. They might just try going for getting pregnant without any help or advice. One of my patients was having intercourse every day and not getting pregnant. I told her to stop that, you don’t need to have intercourse that frequently because the sperm needs to regenerate and all the energies need to rebuild in between intercourse. Studies show that if you have intercourse once every three days, eventually you are going to hit ovulation. Within a three month period, you are likely going to hit the best time to conceive. And sure enough, after they stopped having intercourse every day, she was pregnant the next month. So again, misinformation keeps women from going to the doctor and trying some other crazy stuff rather than getting information that is bona fide and true. The idea that the male is harmed if you have an IUD is another piece of misinformation.
What all of that does is construct fear. It constructs expectations of negative outcomes. And there is the famous misinformation that you cannot get pregnant after you are 35 years old. That is one of my favorites, and believe me, I have had plenty of women and probably so have you, say I’m over 35 and I can’t get pregnant now. That is a distortion of the truth. So is if you try for a year and don’t get pregnant you will never get pregnant – another one. Some women tell me their periods have been so irregular that they must be infertile. All that is misinformation and they also get interesting advice like you just have to try harder. It really does not work that way.
And there is the big issue that fertility is a female problem. That is absolutely not true. 40% of the time it’s the male’s issue. So this is why in my practice, I see both the man and the woman. I am happy to see the woman and get her periods in order before we move to my fertility protocol, but I insist on seeing the male part of the conception team because if his Dai Mai is blocked, his reproduction is not getting appropriate energy – the kind of energy it should be getting. So I really do work hard on making sure that the male comes in for treatment because for another thing, he is suffering from fear of infertility and dealing with the female’s emotions; they’re both lumped into this big worry thing, in a fear experience. Therefore I strongly recommend that you also treat the male, that you treat couples with fertility challenges, not just the woman. The male has an impact on conception.
In traditional Chinese medicine, the kidney system is a powerhouse right? The fire in the belly is one of our most important energetics systems. It is the root of pre-heaven and post heaven qi and kidney essence is a combination of those. It is very important for growth and development and sexual maturation after puberty. It more focuses on reproductive function and fertility in adulthood. And, as it declines with age, we get things like loss of teeth, hair loss, the symptoms of menopause. We do eventually become unable to conceive and then of course we have impairment of cognitive functions. So maintaining good quality kidney qi is important for us and as practitioners, understanding the relationship of fear, kidneys, and fertility is important.
It is the kidneys that fund all of the pulse positions. So if kidney qi is scattered, if it is not well formed and weak and scattered, then how is it going to support all of the other systems? So if it looks like this, all those little scattered points, then it is going to be hard to fund all the rest of the organ systems. In addition to regulating the body fluids and growth, the kidneys also keep yin and yang in balance. That is partly why it is so important to balance, to make sure that the kidney pulses are balanced and strong, because as I just said, they fund all of the other organ systems and keep yin and yang balanced. They also govern body fluids so tears, saliva, perspiration, and fluids that lubricate all of our joints are regulated by the kidneys. They store the life force and are associated with the healthy transitions through life stages.
So from childhood, early adulthood, all the way through the aging process and then separating as we get closer to death is how they work. It makes sense that we need kidney energy to live so it also makes sense that we need it to procreate. But that energy, kidney energy can become lost and scattered as a result of fear that men and women have about the possibility that they cannot conceive. I know you see more women and they are the ones who almost always make the phone call/appointment about being infertile or having fertility challenges. But I can tell you from experience that when the male of the partnership is involved and treated, everyone is a little more calm. They understand the situation a little better instead of it all being a woman’s problem, just a woman’s problem.
We know that stress can negatively affect the ability to conceive as well. So does fear. The fear that people have that they are not going to be able to get pregnant and carry a healthy pregnancy through a healthy birth, can and does negatively affect fertility. Just like we know that stress can make irregular periods it can also cause lack of ovulation. Fear also can negatively affect sperm quality and motility. So there again, we have information about fear and stress. We also need to treat the male partner to manage hormonal imbalances. Stress can wreck the hormones which can also have a negative effect on someone’s ability to conceive.
Besides the usual and customary pulse positions, we all know what they are, my system also includes on the left kidney side the uterus and the prostate. So the left kidney side is where you are looking for uterus and prostate. And it is on the left side where you are going to follow the pregnancy. In the beginning it feels like a little blip, a little knot upward hitting your finger. But as the pregnancy goes on, that knottiness gets bigger and feels stronger in the pulse.
So let’s go on to what does a scattered kidney pulse feel like. First of all, you feel the kidneys with deep pressure. So there’s a lot of pressure with your fingers down on the pulses, and you should be able to find the kidneys there. But when there is fear in the system, the kidney pulse feels what I called diffused or scattered. That means that it is scattering under your fingers instead of feeling like a flow. A flow between the organ systems is what we want to feel. We want to feel a flow like a river. But fear makes it feel more scattered. I describe it as – you know how fireworks start out strong right? There’s a boom, they go up in the air, and then they fall down in the air like this – like little points of light. I like to say that’s how the kidney pulse feels when fear is involved. It feels like little points of information on your finger, like little fragments of the pulse. If it’s that scattered, there is no ability for it to move forward and fund the rest of the pulse positions. That is the main problem with fear.
We need to get the kidneys open and flowing in order to make the rest of the positions work correctly. One of the things we need to remember is that fear is going on and that it is damaging the source qi. It does not allow the kidneys to have regular pulse form. In other words, the sine wave, yang and yin, yang and yin – it doesn’t allow the flow to the rest of the meridians systems.
So here’s a picture of it. As you can see, this is the left side, kidneys, gallbladder, liver, small intestine, heart, and then those little dots in the kidney position. That is how the kidney pulse feels under your fingertips when it is scattered. When you are feeling the pulse and the person has fear, it is scattered. You might not say the words to them, do you have any fear in your life? Sometimes you need to just ask about stress or ask about the period, ask about their digestion, the things that are funded by the kidneys and you can then move onto a more specific question about fear.
I have a case study of a woman who I felt fear in her pulses. She was only 34 years old, no reason for her to be infertile, but of course the fertility clinic told her when do you want your IVF? She said she knew an acupuncturist who helped her daughter, who happens to have lupus, get pregnant and have a successful pregnancy so she was going to do that first. Of course, they told her we will see you in three months, we’ll go over your blood work and your hormones again, and then we will schedule your IVF. But she was determined that she was going to get pregnant naturally. So I was feeling her pulses, and could feel some fear but from the outside her life looked wonderful. She did not have any health problems, both of the couple had good jobs, they were happy for all intents and purposes. So I asked her about her childhood. She said it was perfect but then as we talked about it more and I told her about the fear I felt, she remembered that she grew up in a small European country during war time. I asked her if any of her brothers or her father were involved in the war. Did they get hurt? She said no, it was just normal life but there was a war going on and when that sort of history is with the patient, we need to study the pulse is the kidney pulse is a little bit more.
As I said earlier there are a number of big issues when the kidney qi is scattered because all of the organ systems are funded by that. When I show my patients their pulse picture, I always show them that, that these kidneys, the section right here in the middle, is what’s funding everything else. It is funding all of the other organ systems. So it’s really important that the kidney qi be secure and have a flow, have a movement instead of there just being little pieces of it.
As you can see, because the person probably has some anxiety along with their fear, the liver energy is using up the little bit of the scattered kidney qi and attacking the heart small intestine position, and making the person even more anxious and more fearful. So this is the importance of knowing how to feel the scattered kidney pulse so that you can consolidate it and it can work with the other systems.
That is a perverse movement in the liver right? We want all of the organ systems to be nice, smooth, sine waves. So that is for me probably the biggest issue of the kidney qi being scattered, it cannot fund the rest of the positions for good health. So all of the positions are going to suffer. And when you get a perverse movement like that here in the middle jiao, the problem with that is that it’s using whatever kidney energy is in there to fund that perverse movement rather than fund healthy movements.
As I said, the arrow at the top is where the liver is attacking the heart and small intestine. Now you will notice it goes into kind of a block. Because our systems are all made to protect the spirit. We are not going to let any perverse energy into the spirit. That’s what our body is always trying to do. So this is why we need to resolve issues like that, in the liver, that frustration, because when the heart is blocked, when the spirit part is blocked, not only does the person not feel any sadness but they don’t feel any joy either.
And as you can see, the scattered kidney pulse can lead to the other organ systems getting out of balance. Also remember, heart blood goes to the uterus. That means the heart manages blood. So if it’s blocked like in this picture, then it’s not helping the uterus at all. So again, putting together all of the functions of all of the organs, letting the kidneys fund everything is the key. They need to be in order, if they are not, then they are going to let the other organ systems get out of balance.
If the liver is attacking the heart and small intestine position, it is unable to do the blood flow to the uterus. The patient is even more anxious and sad. And it is partly because the fear is in the scattered kidney qi.
If you look at the right side where it is kidneys, stomach, spleen, lung, large intestine, you would see perhaps a dip in the digestion, a dip in the Earth spleen stomach sector, because again, the kidney qi on that side is scattered and cannot fund digestion. And we know that digestion is involved in blood flow also. So if the person’s digestion is not working well, then they are not making good quality qi or good quality blood either. And that’s what we need for the uterus. We need a nice, warm, blood-filled organ in order to be able to conceive and carry through a pregnancy, a good strong pregnancy. Because remember, the completely healthy childbirth – everybody is healthy – is still a small percentage of what happens. Many times there is some sort of complication like preeclampsia, high blood pressure, something going on so the healthy live birth and healthy pregnancy is still not 100% of the time. So this is why it is important to see your patients during their pregnancy, not only to help them get pregnant. They come to see us, they get pregnant and they think, OK, I’m good. My treatment is over. No, not really. For one thing the Dai Mai is probably blocked during the whole pregnancy. This means come for treatment, let me open the Dai Mai, let me get all the blood and oxygen flowing again instead of being stuck.
In the beginning when we help them get pregnant, they always want to say hey Dr. Martha I’m pregnant. But your treatment isn’t over. Don’t let things get to having headaches every day, or back pain every day, or morning sickness every day. Don’t let it go there before the person comes in and gets treated during their pregnancy. Keeping everything open and flowing is important. We will keep their digestion moving. If they wake up tired in the morning, it’s not because they’re pregnant, it’s because the digestion isn’t working well.
So realizing and remembering how important it is for all of the organ systems to work well, even during pregnancy or especially during pregnancy, is an important thing.
Now what treatment can you do for somebody who has fertility challenges that are related to fear? As I said, you need to get healthy kidney qi going. You need to get it bound together with the other organ systems. I say here, remember, a blocked Dai Mai is going to prevent that. So even if you don’t know how to feel a blocked Dai Mai in the pulses, open it anyway. There’s nothing wrong with using that extraordinary channel. You see a pregnant woman, you open it, then you know that it’s going to keep flowing through that area. In fact, a blocked Dai Mai may be part of the problem because it is affecting ovulation, menstruation, and in men affecting men’s ability to be a conception partner. So it is always important to remember about the Dai Mai.
And the Ren and the Chong, they help reinvigorate kidney qi and also the Chong helps with emotions and digestion. The Ren Mai of course, helps with any kind of fertility or menstruation issue even libido. For example, some women get dryer. They get symptoms of dry vagina and they say that they lose their libido and really do not want to have intercourse. They want to because they want to get pregnant, but it doesn’t feel very good. So knowing all of that and the ways that we can help that with acupuncture and herbs, will help the person.
I sometimes just do channel work also, I don’t do particular points. I just want to make sure that the meridians are all flowing. So needling the channels like kidney, bladder which is water, so moisture, get the kidney qi flowing, get it built up through the bladder channel. So it doesn’t necessarily mean certain acupuncture points or that I have a specific protocol or scattered kidney qi point formula because everyone’s pulse is different every time you see them and so it’s important to deal with what is in front of you at that moment.
And then there is lifestyle advice for people. We know that the kidneys are traditionally sensitive to cold, so we would like the person maybe to put a hot water pack on their back just to help warm up the kidneys. Eat warm foods, your water – drink it at room temperature instead of from the refrigerator. Some people say keep alcohol and things like coffee to a minimum. It depends on what their lifestyle is. If you are yin deficient, obviously you don’t want to be drinking three pots of coffee a day. So it is all about being aware of the patient’s lifestyle. We know that a little salt is beneficial to the kidneys. It is why when you crave salt, you know that our kidneys are a little out of balance. The color is traditionally black or blue so black or blue foods to strengthen and nourish the kidneys. Things like eggplant, black sesame seeds, and other foods that can nourish the kidneys including walnuts, figs, brown rice and other grains. Asking your patients to change their lifestyle is completely acceptable. One of the ways you can help them is by giving them food ideas that are going to help the kidneys.
And then there are other ways – meditation or at home Qigong. Try to control their emotions that are leading to the fear response in the kidneys. You can show them Qigong circles on their belly to help their digestion, do them clockwise. It’s a little Qigong massage; it doesn’t have to be a hard massage. It can be barely touching the belly. Meditation is just focus. Studies on meditation don’t even like to call it meditation, they call it focus. So find five minutes a day to focus. Focus on a bird singing, focus on a candle, focus on a chant. Five minutes of that a day will change your brain to be more calm. It literally changes your brain to reduce fear and anxiety. Have them do some sort of at homework to work along with your treatments to help them boost up their fertility chances.
With all that, I want to thank you very much for attending and I want to again thank the American Acupuncture Council for sponsoring this webinar.
Next time we are going to talk about worry and fertility, so I hope you’ll be able to tune in for that. This is Dr. Martha Lucas, my website for teaching is lucasteachings.com and my private practice one is acupuncturewoman.com; feel free to contact me.
And I’m going to be speaking about treating infertility with Chinese herbs, with Moshen herbs with different, we’re gonna talk about one formula and how we can adjust it.
Click here to download the transcript. Click here to download the slides.
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.
Hello. I’d like to first of all thank the American Acupuncture Council for having me today. And I’m going to be speaking about treating infertility with Chinese herbs, with Moshen herbs with different, we’re gonna talk about one formula and how we can adjust it. And and I also wanted to let you know that I have another I will be having another talk about another two formulas, which are very Very applicable to this season, which is spring season.
One is called React and is used for allergies. And the other one is called g shield. And it is used for improving the immune system. So those are very relevant to the spring which is in its might. AC activity right now, and I you might be feeling it a little bit itchy eyes, nose, throat, and all the pollen is everywhere.
So happy spring and let’s start talking about the subject of today. As I mentioned, I am going to be talking about actually one formula, but two different variations of it that supports fertility in both genders. So the first formula, I named it Sprout and it’s the motion herbs formula for supporting uterine fertility.
And the other one is called Seed which is the motion herbs formula that supports sperm fertility. These are, this is going to be what we’re going to be talking about today, but I also wanted to start by talking generally. How do I approach treating fertility in Chinese medicine in general?
The first concept I wanted to discuss is yin and yang. This is something we all know and really is really an important aspect of regulating the body and preparing in, especially in preparation for conception. And of course yin and yang has to be balanced. The reason I wanted to mention it today is because I’ve been noticing in my office in the years that I have been in practice that I need to focus a little more on yin than young when I treat patients with fertility, and I my assumption is that this is due to the fact that.
our lives are in this modern society is very active and fast and moving, and we have too much too much, too fast and not enough downtime and not enough yin in our life. It’s becoming much more young and there’s much more young expectations from us. We need to perform, we need to support, we need to do all the things that kind of weigh on our young, but in order to create more young, we definitely need more yin.
So I find that a lot of times what I see is that there’s I need to focus on creating yin, not only in. Treatment, the treatment itself but also in supporting the patient in the process of getting ready to conceive. That means talking about foods that support in it means talking about activity and rest and so on and so forth.
So one of the basic things that I recommend for women and men who are trying to conceive in the process of getting pregnant One of the main kind of yin foods that I recommend is bone broth, and that’s just an example. So for all my fertility patients, I usually recommend to u to to use bone broth, almost like a supplement.
So they’ll have at least a cup of bone broth every day to support that yin. . And then we also discuss the idea of making sure that sleep and rest is part of the the general lifestyle and that there’s a lot of focus on that. And that leads me to the idea that we really always, or frequently, I find that I really need to work on strengthening the gene.
And what does that mean? In general that we are looking at Jing strengthening as we all know Jing is a really important aspect of. Of fertility especially in the idea of chi. In Chinese medicine we know that Jing is really if Jing is deficient, our ability to conceive or to produce sperm or to produce eggs is reduced.
And A lot of times because nowadays conception comes much later in life than the jing as we age is reduced. And therefore there’s always need a need to support or evaluate how much we need to support Jing in both genders. We will discuss the herbs that really work on strengthening jing, but also, as I said, lifestyle is a huge con aspect of preserving.
even supporting or strengthening the gene. And again, that is looking at diet, looking at activity and rest and and also making sure that you are using some kind of a an exercise that is not only cardiovascular, but also meditative, I would call it like yoga or chigong or anything that the patient feels comfortable with in that aspect.
So when we are supporting the uterine health, of course we are not only looking at Jing and yin and yang, but also at the health of the blood. And the health of the blood is really pretty important as we might assume. In, in, in conception. And a lot of times that is a really important thing to evaluate in a patient, to understand how to treat them.
On top of checking, what’s the. What how, what, how strong is the jing? How strong, how balance is the yin young. We also need to regulate or check the blood health and also the liver. Liver liver. Health, I would say meaning is there a liver cheese stagnation as part of the diagnosis?
Is there or is there a liver blood deficiency as part of the diagnosis? So we need to understand that in order to best support the uterine health of a female patient where When we are supporting the sperm health, we not only need to look at the things that we that I mentioned before, but instead of blood, a lot of times I evaluate the relationship between the heart and the kidney.
as I really think that the concept is that the one the heart fire is in relationship with the kidney Jing to allow for the production of healthy sperm. So I look at the kidney fire or kidney heart balance when I’m evaluating. The sperm health as part of the diagnostic process. So these are all really important things and we as we will talk more specifically as we go through the formulas to understand what kind of herbs you might be thinking of in each of those cases.
So let’s start with the formula sprout. Which is the uterine fertility support and it’s was created based on the Formula One shall down and it’s a one shall down. Is really Important formula. I think for for supporting fertility, it’s, as a base formula for supporting fertility.
The translation of that is rejuvenation, special pill. What it means basically is that this formula is made to. Revive the jing in a sense. So it’s a Jing Tonified formula and when I created it for the use of sprout for female fertility, I added herbs that support chin blood. As I mentioned before it is really important that we look at the blood as well as the function of the kidney.
Balancing kidney ian and young as, and as well as regulating the liver making sure liver blood is really full. And also that liver chi is flowing harmoniously. So this is all taking care all part of the creation of, or the formulation of the, this formula. So I’ve looked at many herbs and how do I Ma adjust the formula to support the natural potential of the body to, and how do I strengthen the kidney energy and support the jing and really regulate and strengthen the liver?
And so I have used different, I added different herbs like Xianchen which. A really important herb, I think in the, in supporting both the spleen energy and the fluids and the yin of the body. So this is American jining, as you may know which really helps to not only nourish chi and young, but also supports kidney.
Yin. Therefore, I think it has an effect on supporting Jing. I also added Zu as a way to consolidate the kidney energy and help with. With holding on to the Jing that has been created as well as to support Liberty Tea flow and also calming the she and spirit. So I also in both Sprout and in seed, I added Herbs outside of our Chinese herb preparations or varieties.
I added in sprout two Ayurvedic herbs. One is called, one is Ashwaganda, which is. Pretty much the Indian Jining or sometimes referred to as the Indian Jining. It is a real balance and it’s like parallel to the the American jining in its ability to. Both give support the young, but also in a calming way and not overstimulating, and also added chat, which is asparagus root for its calming, nourishing, and yin building aspects.
To support the formula’s yin building ability. So if we look at Sprout the on the left, you will see here the main, the herbs that I, that originate from Huang, Shadan. I’ve reduced some of them, eliminated some of them, and and substituted with others. On the right side of the four of the list, as you can see here the interesting thing, one of the main herbs in Huang Shaan is Shaya which is basic chi tonic but also, Generates fluids and really helps support the transformation of fluids and and nourishing the, in nourishing the yin.
. The other herbs that are included is and are the two young produ young strengthening form herbs. . So these young strengthening herbs especially barian, have a very moish nature. Therefore they really support both kidney young, but also kidney jing and and they’re very balanced in that way as well.
We, I also added two herbs two herbs in the formula that is . Both support yin and blood and and Jing also in, for that matter. So these are the herbs that are, or from the original formula, which is Shong, which I mentioned before, wan and Zu. These are all the original formula of but I also added another.
Two herbs that really support the young, I added and wan to enhance the young ability the young strengthening aspect of this formula. But as again, both Tu and are also support the and are not too stimulating in terms of young activity. I added the next group of herbs is SH
and Za. These are all focused on strengthening the Central Chi. Sharon helps in moving the chi in the middle burner, as well as supporting it and is really important. So to, to reduce the. The CLOs of some of the herbs that are in this formula. So it’s there also to support that.
The next set of herbs are UE and UE and which really help in nourishing blood and supporting liver. The liver blood in particular. And then the following set of herbs is
Ma sorry, fu and which help to move liver chi and also calms the. . And then finally we add, I added some herbs that support the Kidney that, sorry, the uterus. These are herbs that are sometimes used for what, what is called concern for miscarriage. So these herbs help to calm and nourish the uterus and prevent prevent any, Danger of miscarriage.
So these are ngk. Then the last two, as I said, were the ashwaganda and Shava, the Ayurvedic herbs. So this creates a very rounded formula. I’ve used, I’ve been using this formula to support my fertility patients for many years before coming out with it. With motion. So I know from my experience that it works well whether in any case, when you are working on a fertility patient, you will also need to address, and you could do this with acupuncture, with some diet, with some lifestyle recommendation or with Or if you are actually, making a specific or making a a formula for your patient, you will definitely need to evaluate the specific constitutional imbalances of each patient to really address the more specific needs of every patient.
So every patient has more needs. So Sprout is a general formula, trying to hit the most common disorders and supporting the most basic needs of anybody going through fertility issues. That could be a support formula for you, but please make sure. Whether with acupuncture or with other techniques that you support the more individual aspects of each patient that you are trying to support their fertility.
When we talk about seed, which is the ba which is the formula that I use to support sperm health. Again here we use the same formula Huang shall done to be our basic general formula. But I’ve modified it again to. Sperm health by addressing a variety of common presentations that happen with males who are, or males who are looking for support for their for her, their sperm quality.
But also I usually would recommend if a woman is coming to get or help with their fertility. I, and I’m not seeing necessarily the. The other part that I recommend that they take seed to support their health qual their sperm quality. So it, what I took in in, in account when I was forming this formula is, Different issues like how to support sperm count, how to support sperm motility, and how to support sperm morphology.
So I included herbs in all for supporting all those aspects as well as different constitutional aspects and the stresses that we encounter in our day-to-day life. To help in calming those to so that we are able to form a better quality sperm. So from a Chinese medicine perspective, we really st focus on strengthening the jing and also regulating the liver chi, as we all know, the liver chi the liver.
Channel really and circles the gen genitalia. And therefore once we move the liver chi, it helps in circulating the chi around the testicles. And that’s really important for a lot of men or people who are trying to enhance their sperm quality. Always address the liver.
Whether it’s, again, with acupuncture and points that really help to promote the circulation in the genitalia area points like liver five, for example. It’s one of my favorite points to help with that and really get chief flowing in that particular. And also I really take a very specific look at this.
What’s the balance between the heart and the kidney? A lot of times what we see, if there’s too much heat in the heart and not enough young in the kidney, that means that maybe we need to regulate or try to balance the two. And I always believe that the. That the sperm quality is much influence, both, both the all three aspects of sperm health is affected by this balance of energy between the heart and the kidney.
So I always, I. Take a really deep look at what that balance is in order to try to harmonize it and make it more harmonized and Therefore I think the herbs or whatever you’re doing might work better too. And our, the body will create better quality sperm. I’ve modified the base format, the Aldan, by also adding some Western an Ayurvedic herbs, including Demi which is a western herb that used for increasing libido.
And as I mentioned Ashwaganda before in the other formula. That has really shown, there’s some actually research, actual research that shows that it increases sperm count. So this is another addition to the formula. So let’s take a look at the the structure of this formula because . One of the things that is helpful, I think that especially if you’re doing herbs, you can use the idea that I used here, but also adjust it.
If you want to create your own formula, you can adjust it to the needs of your specific patient. As you can see, the first herbs that I’ve our first herbs in the list are, her and all are really important herbs for increasing jing and blood and yin. We know is a really important Jing tonic.
That is, that is, I found I thought it was really important to add to this formula. And as we mentioned before, and is part of the are part of the Huang Chan combination. The next herbs. Zu and Tu are all herbs that help to Shia of course, is part of Huang is as I mentioned, it helps to support the kidneys, but also through strengthening the spleen.
And then we have Zu U, which is. As stringent as well. Astu Suzu Shri is actually part of the al down formula to Suzu. Also and you saw that in that I added that to sprout. We as I mentioned before FU and Newgen and. Are both also as stringent herbs that help to consolidate and strengthen the kidneys.
And are really important herbs for regulating the liver and helping bringing down that young. Especially in muan, p, we know helps to bring down the young and prevent any liver, young rising. So it balances the liver chi. And and also Baha, we know helps to with liver blood.
Then we have sh wonk are really important strengthening the chi herbs. And then we have y
Sue Young and are. Really a group of young strengthening gin Jin Tonifying herbs. In this formula. Then I add Chen, which helps to regulate the blood and connect the kidney and the heart and the kidney. So it really is helpful or supports this kind of connection between the kidney and the heart as well.
That strengthens the kidneys and cre and support circulation. And Huang are another two herbs that I added si for its balanced or support of kidney Jing in particular. And Huang Jin is also a fantastic underused, I think herb for supporting kidney gene and in strengthening the blood overall.
That’s the group of herbs, the Chinese herbs included in In seed. And then we have we have three herbs added to that damiana and ashwaganda, which I mentioned before. I also added So Palmetto because of its effect on. Supporting prostate health as well as balancing the body’s I think yin yang balance by making sure that there’s the eliminating the.
Testosterone that might be circulating in our system. Those were the two formulas that I wanted to review. I wanted to, again, really thank the American Acupuncture Council for supporting these webinars. And you can have the website of motion herbs on the, this last slide. Thank you and please visit us at the above website for more information.
But let’s talk about making sure that when you are dealing with insurance or dealing with claims that you’re not getting these common errors and common denials that are so frustrating because we wanna make your life a little simpler.
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 everyone. This is Sam Collins, the coding and billing expert for acupuncture, the American Acupuncture Council, and you the profession. As always, we’re trying to make sure your claims are getting paid. You can make your life a little simpler and more profitable. and you can do what you like to do, which is care for patients.
But let’s talk about making sure that when you are dealing with insurance or dealing with claims that you’re not getting these common errors and common denials that are so frustrating because we wanna make your life a little simpler. Again. I want you to be able to treat patients. Let us take care of the billing part.
Let’s go to the slides. Does that talk about common denials and how to correct them? What goes on for acupunc? Why do claims get denied? What are some of the common things that we see? The most common thing that I run into, and I deal a lot with this, I lecture every year to thousands of you, many of you’re members of our network service, and one of the issues we run into, you’ll get a denial that says, The plan is not covered and you think I did the verification.
How is this not covered? What happened? One thing I want to really implore you to do is make sure you understand the coverage the patient has. Often you will see coverage that will say, we cover acupuncture, and you think, great, you’ve verified it. They cover acupuncture. Then you send a claim and it comes back denied.
What do you do? First I’d look to make sure was it really covered or ask this question. If there’s coverage for acupuncture, must the provider be in network? A lot of plans do have acupuncture benefits, but only for providers who are in their network. So don’t be confused. Often you’ll call and hear all these great answers like, is acupuncture covered?
And when they say Yes, you hang up, or you hang up and say, great, that’s phenomenal. Then you send a claimant, it’s not paid. It’s because you didn’t ask that other. is the coverage for in or out of network providers. And then I would further ask this question, do you see my office as in-network or. , if you’re out of network, is there no benefits?
So let’s often make sure that the plan, you know what it’s covering. Also know the types of coverage that it has. What does it cover in the sense, does it cover acupuncture alone? Does it cover therapies? If you do therapies? So be careful. That is a common area of denial. Make sure you verify the coverage.
The other area that we run into lots of problems with are claim forms. We’ll get into those specifically, but how to fill it out. None of it is very. But there’s a couple unique things. If you don’t do correctly, will commonly come back and it’s very frustrating. What about just improper diagnosis?
That’s certainly an area improper use of A C P T code, if you will, but also just missing a modifier and you’re gonna wonder what modifiers do I need to do? Don’t give you a quick primer on that today to make sure we’ve got the right information, but also make sure you don’t run into the one where it says insufficient document.
Is, do I have enough information to make sure the claim gets paid well? Let’s talk about claim forms. What are some of the common things that I run into that offices have? When someone comes in, they’re gonna present an insurance card, and on that insurance card we’ll have their information for the claim.
That’s what goes to the top part of this claim. Whether or not it’s a standard or group health insurance plan, or maybe it could be Medicare under some circumstances, but nonetheless, check that off properly. But the bigger issue. Do I have the patient’s name proper? Please note it says here, patient’s name, last name, first name, middle initial, whatever it is, make sure it’s exactly as appears on the insurance card.
So often I’ll see denials because the patient will have a name that they’ll say, oh, just call me Patty. When on the card it says, Patricia, don’t put nicknames. Also, make sure you’re putting the exact insurance ID number. We will often see numbers transposed. Because it just goes in and makes a quick error.
So do make sure now, once we’ve got that set, that ends it, but it’s nothing more frustrating going, wait a. , what information do I have to have? And this is often concerned. Many times it’s gonna be the patient and you’ll indicate self, but what if it’s the spouse or the child? Often you’ll put the patient’s name here, but if the name is different on the car because maybe it’s a child or it’s the spouse’s plan, remember their information goes here as the insured’s id.
so be careful. Sometimes the patient may be different from the insured, though they’re both insured. It depends whose name is on the card. So don’t run into that common era. But here’s a big one that comes up quite a bit. What about block 14? When you’re filling out the 1500 form and block 14, it says, date of current illness.
And so many people look at that and say what does that mean? What do we put in? Were you gonna put the date generally of when the patient had the first symptom and or an injury? But often you might say This patient had an injury or this pain has been there for years. Obviously if I put something 20 years ago, they’re thinking why are you putting that date down if it’s a very old date, or it’s a type of a chronic condition that continuously flares up?
Always update this date to the date where the patient presents to the office. So it doesn’t always necessarily have to be a date of injury. It could be the date of the first visit, but do make sure it’s completed and put in this area. And one quick note, if you’re billing Anthem, Anthem is a little bit weird.
Anthem wants the date of the first symptom here, but they also want to block 15 the date of the first visit. So this could be a week ago, and this is today’s date because it’s the first visit. And then the qualifier you’re gonna put there is 4 54. I know a little bit odd, but 4 54, that’s gonna be Anthem policies.
Anthem policies seem to require that a little bit more than anyone else. Now, again, just Anthem. Now the other area that I commonly see, and this is really a big issue for acupuncturists, is not having a complete code. Do make sure if you’re using coding, make sure that code is complete. Often you might be using a code that’s a little bit old.
Remember, codes do update. Some codes are three digits, some could be as many as seven. So please make sure if you’re using any coding, assure your codes are correct with a number of digits. Notice this one for just pain. R 52 is just three characters, yet this sprained strain. Is all the way up to seven characters, so do make sure it’s the proper one.
But here’s one to keep in mind though. , it’s more important to know what codes are gonna be payable for acupuncture, and this is where things get tricky. Last time I did this class with you, we talked about specifically certain types of insurances, specifically Aetna, on what they cover. Let’s look at a few other ones.
Here’s the company, American Specialty Health, and as you’re aware, well aware, they manage a lot of particular companies, particularly Cigna, some of the Blues, some Aetna plans as well. And they use what I call , I don’t know, physical therapy or chiropractic end of coating for acupuncture in that they want the neuromuscular skeletal type pain things.
Notice the things that they cover, headaches, hip or knee pain with osteoarthritis, extremity pain with or without osteo osteoarthritis or mechanical irritation, and just other syndromes related to the joints in muscles back and neck pain. So you’ll notice that’s not including like abdominal pain in other internal symptoms.
It’s really musculo s. Except for nausea and vomiting. So no, for this plan, if you were to code abdominal pain, not gonna cover, but if you code low back pain, it will. Now also, keep in mind, some things could be tricky. If you’re ever dealing with a Medicare advantage plan, common denials are because you’re using the code thinking, oh, I need low back pain and put M 54 50, when in fact, for the Medicare plans, whether it’s Medicare, part B, or.
You have to have M 54 51 or M 54 59, so it’s good to understand the nuances of what’s covered. Here’s an example of a course, the one we went through last time, which is the Aetna plans. These are the codes they cover, which tells me if you bill these codes, they’re gonna pay you. Bill something not on the list, they’re not gonna pay you.
So it’s important to start to learn the nuances of what codes are covered or not covered. That’s one of the things that we cover in our seminars. Or more importantly, if we do one-on-one as a network member, I can go over with you. Here’s what Health Partners has, here’s what UnitedHealthcare has, cuz it’s important to know what codes are payable.
Nothing’s more frustrating thinking something is. and it comes back not covered all because you didn’t understand the codes that they require. Another area that commonly comes back is that hey, I build for four sets of acupuncture. . They only paid me for three. What’s going on? Or sometimes, maybe they paid me for one, depending on the plan.
Under the standard rules, and this is across the nation if you will, there’s something called the medically unlikely edits. And what, these are the maximum number of services that are payable per a visit, and this includes all types of chiropractors, physical therapists, and so forth in every code or service.
Has a maximum number of services or units that they will allow. In this case, for acupuncture, it is three. They allow up to three. So if you bill more than three, they’re not going to pay it. They’re simply gonna bundle it. So do keep in mind it’s three, I’m sure you’ve seen as if you’ve ever dealt with the va, Cigna, United, and many of them.
Now, are there some plans that may be. Sure I’m familiar with plans out of New York, particularly New York ship that will generally pay up to four. So I’m certainly gonna say, bill, what you do, but do understand some plans will max out at three. So that denial is simply one of just fruition. They just don’t allow any more than that.
So again, if you’re billing more than three, that could be an issue. The other issue for acupuncture though, Modifiers and denials. So you notice here’s a claim form someone with simple back pain. But notice there’s the acupuncture codes billed, but then notice there’s modifier 25 on the exam. This is probably the most common denial I get for acupuncturists, is Sam, they didn’t pay for my exam.
The first thing I’ll ask you is, did you bill with modifier 25? And most of the time the acupuncturist will say to me what do you mean by modifier 20? As soon as they say that I know the reason. Remember, anytime you bill an. With your treatment, any treatment, you have to put modifier 25 on the exam code because this demonstrates that this exam is above and beyond the day-to-day evaluation.
In fact, what it means is what’s printed in bold here, if and only if the patient’s condition requires a significant separately identifiable e and m service above and. The pre-service and post-service associated with treatment. Remember, acupuncture or treatment includes a little bit of an evaluation, so every day there is evaluation.
It’s small, but there is, Hey, how are you feeling today? Is it better? Is it worse? Maybe you’re doing some palpatory findings, tongue and pulse. That small exam is embedded into. the acupuncture code, and that is the reason we put modifier 25 is cuz what we’re stating is this exam is above and beyond what we do on a normal day to day.
and therefore is payable no 25 no money. So make sure it’s there. Now what about a plan that doesn’t cover an exam? That might be a bit unusual, but it depends on your contract. What if you’re contracted with a company like a UnitedHealthcare under Optum, where they pay you per diem? They don’t pay separately for exams because they bundle it all as one payment.
So do keep in. That sometimes it’s a contract issue, but other times it’s just the fact, did I have the proper modifier? Now, you’ll notice none of these other codes have any modifiers on it because it’s not needed. However, what about this last 1, 97, 1 40? I know some of you’ll say I wanna put modifier 59, truthfully, a modifier 59 to indicate a separate services never needed.
However, you will need for some. Modifier gp. Now, this is why I think sometimes acupunctures go, I don’t know if I wanna do insurance at all. It’s just too much hassle. It really isn’t. It’s just understanding the nuances of it. Once you understand it, it’s not hard. So now here’s the rule. If you’re billing United Healthcare, You’re gonna put a gp, G as in George, P as in Paul at the end of a physical medicine code.
So that’s all physical medicine codes, whether it’s from heat all the way through the unlisted service, but massage, manual therapy, you name it. And it’s gonna go on all of these payers, UnitedHealthcare, that includes Optum Health and everything affiliated U M R U P M R, VA claims will. Anthem requires it.
And if you’re in California, here’s a weird one. Blue Cross of California, not Blue Shield. And of course, any of the Medicare plans or federal plans you may do. So again, think of it, a denial will come back and you’re thinking, why didn’t they pay for a therapy? is because you were missing the modifier when it’s one of these policies.
So do keep in mind, focus in on making sure that I have the claim form right, and that’s one of the things I help with. That’s why I’m an expert. I’m here to help you to make sure that you do well and that’s what these short courses are for. Now, one thing to keep in mind, you’re thinking if I’m gonna put a GP.
I’m just gonna put a GP for everybody. Nope, do not blanket it. Don’t include it for plans that don’t require it. Only the ones that I’m showing here. And here’s the final thing I’ll get into is that it’s just INS insufficient information. And you’ll notice here it says, according to 9 7814, it’s not supported.
The medical records submitted do not indicate the needles were inserted and does not indicate the face-to-face time. Now this is something for another course, but do keep in mind if they look at your. Can they tell what you’ve done? Now, here’s something interesting about this claim. You’ll notice the initial set is paid.
They’re saying it was supported, it was the follow-up set. So you gotta start to look at your notes and go, wait a minute, do my notes demonstrate what I need? Do I have the face-to-face time? Does it meet the minimum standards for each individual set? So that includes first set in multiple sets. And again, we need the time face to.
As well as the points of insertion. None of this is hard. Let’s face it, it can seem daunting if you’ve never done it. Once you get a good feel for it, you’re gonna go, wow, that’s really easy. I want you to think of, you sometimes will say, I don’t think I want to take insurance, cuz there’s these hassles. Do you realize the majority of people have insurance and they have acupuncture coverage?
Don’t you think they’re gonna want to use it? I want to give them access. What I have to do is make it simple. That’s what we’re here to. That’s what these courses are for. And that’s it. If you wanna really get some one-on-one help where we work together, we zoom directly one-on-one. You can even go to our seminars for free.
Take a look at the American Acupuncture Council Network. We’re here to support you. Your success is ours. Until next time, my friends.
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