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Microneedling Neck and Hands – MIchelle Gellis

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

Hi, my name’s Michelle Gellis. I am an acupuncture physician, and today I am going to be presenting on microneedling for Aging Hands, neck and Chest. So a little bit about me. I have recently published a hardcover 500 page book on treating the face. So you might wanna check that out. And currently I’m on the doctoral faculty at Yoan University, former faculty member and clinic supervisor.

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At the Maryland University of Integrative Health for about 18 years. I’ve been published several times in the Journal of Chinese Medicine, regular columnist at acupuncture today, and I’ve been teaching facial acupuncture classes internationally for about 20 years. So today I’m talking about a couple of specific topics within the general heading of microneedling.

So I’m gonna be talking about microneedling for the neck, chest, and hands. So I’m gonna go over the benefits of microneedling, how it works, contraindications, some special considerations when you’re microneedling the hands, neck and chest. And then some technique techniques. So why would we do microneedling?

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Microneedling is a great alternative to injectables, things like Botox and fillers and surgery to address things like fine lines, acne scars, loose skin, large pores, crow’s feet, lip wrinkles. Skin discoloration, like dark spots, stretch marks, and even hair restoration. So what does it do exactly?

How does it work? Microneedling stimulates your body’s own collagen production, the micro. Stimulate your body to produce collagen, and it also increases the absorption of any product that you will put on your skin by up to a thousand percent. And in my book, I have pages and pages of references to studies and white papers that have been done on microneedling and how it affects the skin.

I. So the benefits are, there’s very little downtime. It’s very low risk, highly effective, and the collagen that’s produced is your own collagen. So it’s very natural. It’s. Relatively comfortable. There’s very little pain and the results can last up to five years from a series of treatments. There are some indication contraindications.

You don’t want to do microneedling on people that are on blood thinners. People that are undergoing chemotherapy or radiation, people that have really any kind of moderate to severe conditions that are open or oozing that might require medical care, psoriasis, eczema, active acne, that’s pu warts, other things like that.

If you’re not sure, look it up. Speak to your patient’s doctor. Have them speak to their doctor before you start microneedling over any skin condition if your patient has keloids or if they are pregnant. These are all contraindications. So real quick education of the skin. This right here is the stratum corneum.

And so this hole piece right here is the dermal layer and the epidermis. And right at the base of the epidermis is this layer called the stratum basal, and this is where the stem cells. That produce new keratinocytes are formed. So you really don’t even need to get down into this dermal layer, which is where the blood vessels are.

So just by staying in the epidermis, you can stimulate the growth of. New fibroblasts and collagen. So the way the fibroblast stimulation works is these needles puncture. This would be like the head of a microneedle pad, puncture little holes into the skin. They heal very quickly, but they damage the epidermis, and the epidermis heals itself with new healthy skin.

So when we’re doing microneedling, we are going to use different depths for different parts of the face and the neck. And the neck and the chest are very sensitive. The skin on the neck in particular is very thin on the chest. It’s a little thicker. But you really wanna dial it down when you’re working on the neck itself.

So when you’re microneedling, you want to take into consideration the depth of the. Skin, the thickness of the skin that you’re needling and how deep you want those needles to go. Because on a microneedle pen, the needles go up and down and they’re going to penetrate into the skin, and there is a dial on microneedle pens showing you how deep the needles are going to go.

As I mentioned, skin on the neck and the chest can be very sensitive and thin. It can be crepey on the chest. There can be a lot of dark spots on the chest. On the neck, you can get loose and wrinkled skin. So here is an example of an aging neck, and you can see how thin and delicate the skin is here, and then when you’re working on the chest, you get these deeper wrinkles and folds and a lot of sun damage because the sun, when we’re out, the sun is going to hit our chest.

A lot of times we put sunscreen on our face, we put on our hat, but our chest is exposed. So this is an example of what a patient might look like before microneedling and then after, just so you can get an idea, they’re going to be red, but they, there shouldn’t be any bleeding when we’re talking about the hands.

The hands as people’s. Hands get older, they can get very bony veiny, and the veins can be right up at the surface. Their hands can be very sensitive. The skin can be very thin, and because the hands and the feet are so far away from the heart. The healing capacity, there’s the blood flow to the hands and the feet isn’t as good as the rest of the body.

So you can have some reduced healing capacity. So you wanna be very careful not to go too deep. So for a patient like this, when you’re working, you wanna make certain to avoid any prominent veins and to pay attention to any dark spots. I. This was a patient of mine came to me for three or four microneedling treatments, and this is what they looked like before and this is what they looked like after their third treatment.

I had just. Treated them. And I had dabbed at this spot right here, but you can see this spot here is almost completely gone. And just overall the skin on the hand looks much healthier. Little bit about the protocol. You wanna make sure if you’re working on their hands, that the patient washes their hands.

And if you’re working on the chest, you can use a neck. You can use a makeup remover wipe with some rubbing alcohol on it to get that clean. You wanna make sure you put gloves on. And if they would like numbing cream, you can put numbing cream on. I usually recommend like a 5% lidocaine cream, and then you’re going to let that sit for about 20 minutes.

You remove that either with a cotton pad or a makeup remover, white and. Then whatever area you’re working on, you wanna make sure to spray it or wipe it with alcohol, and then you’re going to apply your serum. I recommend hyaluronic acid serum. The product that I use is made by. A company called AccuLift.

It has vitamin C, hyaluronic acid, and collagen. And then you’re going to adjust the depth of the pen and the needle lengths and the speed of the pen according to how deep you’re going to go, depending on the thickness of. The patient’s skin. You’re going to use an up and down technique, and if you’re working on the hands, you’re going to go up and down.

So you’ll be going like this, you are not gonna go across the hand this way. And then if they have any spots, you would use a stamping technique and again, avoiding any prominent veins. For the neck, you’ll be working up and down and on the chest you can go up and down and left to right and use a stamping technique.

When you’re setting up expectations for your patients the results can take. Up to two weeks to see any sort of improvement. And I recommend four to six weekly sessions and the appointments are one month apart. So I’m sorry, not weekly sessions, four to six monthly sessions, and if they wanted to come in for some nano needling, which is a much more superficial.

Needling. It’s more of an exfoliation. They can do that after their skin is healed. So usually within a week. And they do need to know if they’re using any prescription products that they will absorb more quickly. When you’re setting up expectations for your patients, you wanna take into account their skin type, their age, lifestyle, diet.

How much sleep they’re getting. Water, they’re consuming what their skincare routine is, their genetics. Talk to them about their family and how they aged. Of course, your TCM diagnosis, I always include, I. And acupuncture treatment with my microneedling. And any blood, she yin deficiencies, excesses, stagnations, things of that nature.

Some of the possible side effects could be some pinpoint bleeding, redness, itching, burning, a little skin irritation or some pigmentation that should say changes. You also wanna send your patient home with some take home instructions. Let them know they could be red Peel flake for about 24 out 12 to 24 hours and schedule their next appointment for a month out. Soothe their skin with either aloe and Orica blend again. AccuLift has a calm spray. It has green tea.

And aloe and tica and CBD and some other things that are very calming to the skin. They shouldn’t put any makeup on the day of, stay out of the sun. No exercise because sweat can irritate the area, use very mild soap. And after the treatment they should start on a skincare routine. So this is what a microneedle pen looks like.

You have needle cartridges wall charger, batteries, extra batteries, and that way you can plug it in. It should come with instructions and a nice long cord. I recommend a minimum of 18,000 RPMs on the speed for the needles to go up and down for it to be effective and that you should purchase a medical grade pen.

The less expensive pens that are sold online usually are for home use for single person use. Professional pens have anti backflow technology and they are meant the pen is meant to be used for long-term use on many patients. And then the needle cartridges go in the sharps container afterwards.

So this little snippet I just showed you was a little piece of a much bigger class. I teach a four hour microneedle in class and a bunch of other classes live and recorded. You can check them out@facialacupunctureclasses.com. And any of the products I’ve talked about today, you can find@uluskincare.com.

Thank you so much, and thank you to the American Acupuncture Council for this opportunity

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Acupuncture Research for Headaches and Migraine

Is acupuncture helpful for relieving headaches and migraines?

In the United States, each year, approximately 45 million people suffer from headaches, and 39 million are affected by migraine.

A review of 9 studies comparing acupuncture with drugs for preventing migraine found acupuncture was more effective.

The study participants receiving acupuncture were also less likely to drop out of studies because of side effects compared to those receiving drugs.

Healthcare continues evolving to less-invasive, natural, and drug-free methods, with acupuncture now a first-line complementary healthcare choice.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

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Acupuncture for Plantar Fasciitis

How effective is acupuncture in the treatment of plantar fasciitis?

Plantar fasciitis is a common cause of heel pain, estimated to affect 10% of people throughout their lives.

Plantar fasciitis is most common in runners, overweight people, those in occupations requiring prolonged standing or walking, and those with foot alignment issues or who have one leg longer than the other.

Studies on acupuncture for plantar fasciitis have shown overall high levels of effectiveness and few to no adverse effects.

Healthcare continues evolving to less-invasive, natural, and drug-free methods, with acupuncture now a first-line complementary healthcare choice.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

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Acupuncture and Mental Health Issues

Does acupuncture help patients suffering from mental health issues?

Research is currently looking at mental health issues like depression and anxiety, especially in terms of how these issues affect overall health.

Since chronic pain has often been linked to depressive symptoms, research is looking at the impact of acupuncture for addressing both a person’s pain and their depression.

A 2020 study published in the journal Frontiers in Neurology found that migraine sufferers who had acupuncture treatments had a lower risk of depression and anxiety.

Healthcare continues evolving to less-invasive, natural, and drug-free methods, with acupuncture now being a first-line complementary healthcare choice.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

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VA Community Care – Send the Money Back! Sam Collins

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Hey, guess who? It’s acupuncture time. It’s Sam Collins, the coding and billing expert for chiro, for acupuncture for you, if you will, the profession as well as the American Acupuncture Council. I’m gonna speak to you directly as a network service today because a lot of you, and this means those of you who are network members with me, have gotten some letters recently that said, Hey.

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We paid you money for the va, we want it back. This is very similar to what went on last year. So I wanna talk about how we can go to dispute this, ’cause I’m getting several of you with some really big requests for recoupment. So let’s go to the slides and let’s talk about what is going on. And this is coming directly from the va, which is VA Community Care.

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And again, it’s the care for veterans. You have to be enrolled. And remember, if you’re on the East coast, you will be enrolled through Optum Health. If you are in the West Coast, and now when I say West Coast, let me say Texas and west of Texas, you’re gonna be through Tri West. But it’s happening in both areas.

And what it’s relating to is you’re getting letters that are coming to you saying, Hey, we paid you money. We shouldn’t have. We want it back, pay us back. And if you don’t, we’re gonna take it out of future payments. So we wanna talk about how do you really respond to this, what’s gone on and what we need to do.

Part of it I’m gonna say to you is, this is why I hope that many of you are network members with me, because you would’ve avoided this whole thing had you known. Been part of that. We did go through that last year a bit. So many of you’re getting letters similar to this one. Try West. I’ll leave this one small.

But what this does is it’s just saying the purpose of this letter is to inform you that pricing information, allowable reimbursement on claims previously paid you has been adjusted, given the correct payment is lower. We want some money back in this case, $388. Now that’s not very much, but I don’t like paying anything back.

When I do not have to. So let’s talk about what has gone on specifically and what is the issue that’s happening. How do you overpay it? Let’s face it, fees paid for the VA pay at your state, Medicare allowable. So how could to be wrong? I had someone that sent me a letter and said, Hey, Sam. I went through all my pricing and this is what they paid me before.

How could this be possibly overpaid? There could be two issues here. One of them is called the multi procedure payment reduction, and what this refers to is that secondary services on a claim now I’m not talking acupuncture exams, but therapies by example. If you’re billing a therapy, the first therapy is paid at a hundred percent of its normal rate.

But then each subsequent therapy on the same day is reduced what’s called the practice expense ratio. And what this refers to as the practice expense of a service goes this way by example, let’s say I’m gonna do massage for an hour. I have to do a certain amount of setup for that room. That’s the practice expense.

That practice expense doesn’t have to be done. If you think of it, if I set it up for the first 15, do I reset it up for the next? We don’t. So what they’re doing is reducing that portion of it. Now that practice expense comes out to about 15%, 20%. So it’s not a big amount. Let’s say the code is worth 30.

The multi procedure prov reduction would be that it would be paid probably at about 26 or roughly about 15, 20% difference. So not a big difference, but nonetheless a difference. Now, that’s something they should have been doing and they didn’t, so that’s really on them. My pushback is gonna be at least parsing on that.

However, for acupuncture, the biggest issue is not that, because those would be small potatoes. We’re talking three, $4. It is the use of 9 7 0 3 9 and 9 7 1 3 9. So when you get this letter, what you wanna do is verify with them, how are you indicating it’s overpaid? Is it overpaid because of the procedure reduction portion or is it being overpaid because I use 9 7 0 3 9 and 9 7 1 3 9 for cupping.

Please be aware. Since February of last year of 20 24 9 7 0 3 9 and 9 7 1 3 9, were no longer part of the standard episode of Care for Acupuncture, which meant you could no longer use it. I’m hoping some of you go, oh yeah, I remember when that happened, and you were no longer to use that code. Now, of course, if they were allowing it and they were.

Prior to this change 2024, they were allowing you to bill 9 7 0 3 9 for cupping. And frankly, many of you were getting paid 45 to $50 for it. So if someone’s willing to do that, I’m willing to take it. However, let’s keep in mind, let’s think about that logically for a second. Cupping is a much simpler service than acupuncture.

Yet you are getting paid more for cupping than acupuncture. So you can look and go that doesn’t make sense. However, because they allowed it, I’d say, go ahead. Technically, you should have not been using it after last year. Realize here is the newest list of codes I. Allowed for acupuncture with the standard episode of care since February of last year, and you’ll notice immediately none of the 9 7 0 or 9 7 1 3 9 7 0 3 9 or 9 7 1 3 9 is included.

They were removed. Now the pushback that I have, if you’re getting a request for a refund, that was prior to February of 23 for the date of service, the standard episode of care, up to that point. Did include it. Therefore, it would be appropriate for them to pay, and the pushback would be, hey, it was allowed at that point.

Now, if you are getting requests after February 23rd, now that’s a whole nother issue. That’s one that, oh, shucks, we should have known. Now, network members with me, you should have well known because I sent out a lot of information. This is why I’m sending this all directly to you as well, not to mention just for everyone, let’s make sure you understand.

If you’re billing the va, these are the codes they allow. They do not allow 9 7 0 3 9 if you are wanting to do a service that is not on this list. You must specifically get authorization from the VA to provide it, or it’s automatically non-paid. Now I will have you notice. Notice the last two codes in each one, the 0 5 5 2 T, and S 89, or excuse me, 0 5 5 2 T is the code for laser.

So they do cover laser. Don’t get excited. It doesn’t pay that much, but it is covered. So bottom line is do not use for cupping any further. If you have been. 9 7 0 3 9 or 9 7 1 3 9. Do not use them. They’re gonna be a problem. And if you get paid, you’re thinking I got paid. They’re gonna come back and take it back.

I. We’re gonna push back on that a little bit, but again, after February of last year, it’s gonna be a little bit harder. So for cupping, what should you do? I’m not saying not to bill for cupping, I’m saying for the va, however, it is only under 9 7 0 1 6, and that code, frankly, is worth between 11 and $15, which truthfully makes much more sense to me.

I don’t think cupping should have the same value as acupuncture. Not to say that cupping doesn’t have value, but is it as much as doing the needling? I think not. So therefore, yes, it’s still payable, but just under that code. Now, if you’re getting issues on the price reductions, that’s what I would still push back on, depending on when they’re implementing.

But remember, that’s gonna be a pretty small amount. If it’s a big amount, I’m almost certain it’s going to be cupping. So make sure you’re pushing back. How can I dispute it? The number one dispute I have, and this is the starting point, but I want always there to be two disputes, is just plain statute of limitations.

Let’s face it, we have only 180 days to bill the va. Does that give them infinite time to recoup, years later? No. Under federal statutes it’s 365 days or one year. Therefore, if they’re making a request to recoup money from you, that is over 365 days or one year. That’s the number one pushback. If you’re a network member with me, please contact me.

We have a dispute letter to that fact for you already formatted that you can send. Hopefully this is encouraging. Some of you, oh, this is why that network is so good anyway. If you’re not a network member, you’re just gonna have to go back and say, Hey, that’s statute of limitations. I would also push back though on this issue case law, there’s case law that’s been around since the nineties that says when an insurance pays something improper and the provider has not done anything.

To make that payment improper. The carrier is the one responsible under federal rules. They may push back on that, but if you recall last year, we were able to dispute that, but I’m expecting the same. So my hope is that given in another month or so, we should see some pushback where they’re going to no longer seek these recoupments, at least the ones prior to 23 or over a year.

My concern for you though, is make sure you understand, do not bill. 9 7 0 3 9. I know you’re thinking they paid me. They can recoup it. We wanna push back. Let’s make sure the claims are correct. If you’re not a network member with me, this is a great time to understand what we do. This is something we’re trying to get you ahead of the curve and not chasing after it.

VA patients are still very good patients. Remember, we got about a 20% increase in the Medicare fees for the first set this year, so that’s a good patient. Just understand the rules. Again, no use of cupping. If you’re not a network member, please take a look. If you’re a network member, please contact me.

Let’s go through. We can do a one-on-one zoom if we need to, but let’s make sure we’ve got some fire to push back on this. Until next time, my friends, I wish you the best.

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Acupuncture for Back & Neck Pain

Is acupuncture helpful for back and neck pain?

Nearly 80% of adults have low back and/or neck pain at some point.

Twelve studies with over 8,000 participants showed that acupuncture was more effective than no treatment for back or neck pain, and data from 10 studies with close to 2,000 participants showed that acupuncture was more effective than sham acupuncture.

The pain-relieving effect of acupuncture was comparable to that of non-steroidal anti-inflammatory drugs.

Healthcare continues evolving to less-invasive, natural, and drug-free methods, with acupuncture now being a first-line complementary healthcare choice.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.