Tag Archives: American Acupuncture Council

Medicare and Acupuncture Updates

Most of you’re gonna hear something starting now because the Medicare enrollment period begins October 15th and goes all the way through, I believe, December 7th.

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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.

Hey, greetings everyone. It’s Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council, and really to make sure you’re getting paid. What I wanna go over now is Medicare. There is still so much confusion. I do seminars. I travel the world for on behalf of acupuncture. I deal with so many different groups throughout the United States, and I get so many calls from network members that are asking.

Sam, my patient called me and says they have direct Medicare or what’s going on, what’s changed? And what I wanna do is hopefully clear up a lot of the confusion ’cause in fact, Most of you’re gonna hear something starting now because the Medicare enrollment period begins October 15th and goes all the way through, I believe, December 7th.

So you’re gonna see probably a lot of television ads and other things talking about acupuncture and Medicare Part C plans where I find they’re actually using the profession to help promote their own insurance. But then what is the difference of these? What is Medicare? How does it cover acupuncture? Is it different from when it started in 2020?

So let’s get into that. Let’s go to the slides, everyone. You’ll see here. I wanna talk about Medicare and acupuncture update Medicare, part B and C. Do not be confused. A lot of people hear the term Medicare and it realize it encompasses a lot of things. The two areas that focus for acupuncture though are part B and C.

Part A is for hospitals, nothing to do with us. Part D is for drugs. And then supplement policies don’t affect US either, so it’s part B and C, and most commonly people get part B automatically. When you turn Medicare age, but many people now are trading for these part C policy. So I wanna make sure we understand the differences.

’cause part B has not changed when it comes to what type of acupuncture coverage there is. Part B coverage is still limited to chronic low back pain and so forth. So the problem is though, this is the type of thing are your patients are seeing the public, they’re seeing ads like this that says Medicare now will cover acupuncture for chronic low back pain.

They call Medicare and they say, oh yes, you can get acupuncture. Not understanding the differences with regular Medicare Part B. Yes, there’s coverage, but there’s some obstacles or some hurdles to cover to make sure it’s covered. The one that’s a little bit simpler, of course, are the Medicare Advantage plans.

These are the Part C. In fact, I like to use this one ’cause this is taken off of an ad from television for a Medicare advantage plan for UnitedHealthcare. In this particular plan I look at this and I thought, wow, this insurance company is using acupuncture to promote the sell of their service.

They’re letting people know, Hey, come and join us. Don’t have regular Medicare and you can get acupuncture for a zero copay. Is that gonna be attractive to some people? I think so. So certainly wanna look at that. And just to keep in mind, part B is what people automatically get. But many people are trading for the Part C policies.

In fact, you can tell that because look it, there’s ads all over the tv. Here’s one for Clever Care, Medicare Advantage. It doesn’t even talk about acupuncture in this part of it, but it’s showing someone talking about dentists and see your doctor, but showing someone getting needle. And obviously there’s a big push.

A lot of people are recognizing, Hey, acupuncture can be helpful for me. Where do I go? How can I go and does my insurance pay for it? ’cause particularly a Medicare patient, generally gonna be on a fixed income though, could, some can be wealthy, they’re still fixed. They’re joining, they’re, they’ve got pensions, they’ve got retirement plans, they have social security.

So they’re certainly gonna pay with their pocketbook, meaning they’re gonna look to see if they have any coverage. So the confusion comes in when someone comes in. How do we identify them as a Medicare patient? I’ll make a real simple statement. You’ll know they’re a Medicare patient. If we’re over 65, everyone in the United States that is over 65 gets Medicare.

Whether you want it or not, you get it. Now, the part A is the automatic, the Part B you pay a little bit for, but everyone does it. And that’s the card on the left. This one here, you’ll see that’s regular standard Medicare Part B. Notice it’s A and B. The one on the right, this is an actual card from someone that is a Medicare Advantage plan, and you’ll know it as such because you’ll notice right on the card it indicates.

United Medicare, silver. There’s golds and so forth, but you’ll see that, but this one takes over. Don’t be confused when a person trades their policy for a Medicare advantage plan. They’re not gonna make them give back their regular Medicare card. So when someone comes in, always ask them If using, let me see all of your cards.

Because if they have one of these advantage cards, this regular Medicare is gone. They’ve traded for this, and I believe this year is gonna be the first year. Last year, about 48% of people I. Change to a Medicare advantage, Part C, whereas 52% were regular. I think this year is gonna be the tipping point.

’cause these plans just offer generally a little bit more generous benefit and frankly better for us. So let’s talk about regular original Medicare part B, regular Medicare Part B. As far as acupuncture coverage covers only chronic low back pain, which is defined as. Back pain over 90 days. That’s not too hard with an older person, certainly, but still something we have to have.

The bigger issue though, is this. The chronic low back pain can be treated by an acupuncturist, but it must be what they’ll say is under the adequate supervision of a medical provider. Now, I want to take back here, you’ll hear some people say direct supervision, and in many instances it will be direct, meaning you have to be in the same office.

However, adequate could mean . If the medical provider feels comfortable enough working with you, they may not be in the office at the time you’re delivering the acupuncture. The problem’s gonna be, it’s not a simple referral. They can’t just refer to you at another office. You have to be working in the same facility, whether they work in your office and make your office part of theirs, or you go to their office.

So this one makes it a little bit more complicated. It’s probably a little bit easier in this way because it can also be a nurse practitioner. Or a physician assistant who are a little bit more traveling, but you have to be working with them because they’re who are billing it. You’re not billing directly.

You’re gonna be working for them, whether as an employee or an independent contractor. Now, the good news is adequate supervision means you might be able to have an arrangement where maybe they’re in the office two days a week. And on days they’re not there with the prescription, you’re doing the acupuncture and they’re supervising remotely, if you will.

That can be allowed. So keep that in mind. But it is not a simple referral, so don’t get confused. The other thing is they require very specific diagnosis, and I apologize for the typo here. I did redo this short just a moment ago, but the diagnosis codes you’re required to have are M 54 51. Which is vertebral genetic back pain or M 54 59, which is other specified meaning specifying is chronic.

If you use M 54 50, it’s gonna be denied. So I have a lot of people going wait a minute. My claim was denied. The simple reason didn’t have the right code. They do not accept M 54 50. But again, that part B one’s a little more complicated. I do have several offices doing it now that have done quite well.

But you really have to get someone that’s a medical person that you can work with. Remember, it must be medical doctor. Physician assistant nurse practitioner. It can also be a certified nurse specialist. Those three, it cannot be a chiropractor or physical therapist. Now Medicare Advantage Plans. Part C plans are ones that people trade for and frankly, this is the one you can bill directly.

So don’t be confused. Part B, no direct billing by an acupuncturist. Part C. Plans advantage plans will allow you, in most instances that you can, they do have the same parameters of coverage. They cover for chronic low back pain, but many of them offer what we call routine acupuncture, which means they pay for pain management, and these you can directly bill.

In fact, in many instances, you don’t have to be in network. But just willing to provide the service. The one thing to keep in mind though, you will be subject to their fee schedule. If you choose to bill a Medicare advantage, you cannot balance bill your full fee, but the amount they allow, frankly, it’s gonna be a little bit more than Medicare, however, so that part I will say is good.

Now remember, not all Part C policies necessarily will have the additional routine acupuncture, which means direct billing. Most will, but always verify. What I can guarantee is they will all have the chronic low back pain supervised, but you’ll see that coming up. When I show you a little more direct policy.

Now what does Medicare actually pay? And I think this is where a lot of confusion Medicare will pay for three sets of acupuncture. I. The initial set, and this is gonna vary, this is why I have the variation in fees. This is gonna vary depending on where you’re located. Different states, different counties all have different fees, kinda like house prices.

But you can say on average the first set’s probably gonna be 40, though I’m putting 40 to 55 ’cause some states are higher, depending if it’s elector, acupuncture as well. And then the additional set is 30, but it can be as much as 40, again, depending on the area. So I’m gonna highlight that for three sets.

It’s roughly a hundred dollars a visit. Now that does indicate about a 40 minute visit, of course, but nonetheless, a hundred dollars. I think for a hundred dollars visit. I can make that work. It is not great. I’m not saying you’re getting paid thousands, but that’s not bad. Assuming 20 visits, that’s $2,000 per Medicare patient of reimbursement.

Not to mention the medical provider gets to bill for an exam or other services they may do for that patient, but your services would be paid at about a hundred per visit. Now, Medicare part C policy, and I apologize, this is a little bit small. This is UnitedHealthcare one and up here talking about what is covered.

They’re letting you know the same as Medicare. What’s the same 12 visits to start? Eight visits if it’s showing improvement for up to 20 for chronic low back pain. However, many of these plans don’t require and or direct referral because they’ll have, as you’ll see here, acupuncture, Medicare covered, and then they’ll talk about routine acupuncture, which means.

They cover for pain management, and I’m gonna say to you, the majority of these Medicare Advantage plans usually have that benefit. So you’re not gonna be limited to just low back pain only, but just about any condition so long as it’s painful. Keep in mind, however, for back pain though, they too will still require M 54 51.

M 54 59 to give you a good feel for it. Take a look here. It talks about acupuncture C P T codes that it covers, and you’ll see here, even dry needling, if you felt so inclined to do it, I wouldn’t. Dry needling doesn’t pay very well and I don’t think you’re doing that. You do an acupuncture, but the four acupuncture codes, and then it says here, common routine acupuncture codes, not a complete list.

So what I wanna highlight, this plan is noting that they’re not just gonna pay for the acupuncture, but they’re gonna pay for exams. The acupuncture codes. But then notice they’re listing several therapy codes. In other words, they’re gonna pay you within the scope of practice for common services that are payable under the plan.

On these plans, you can see sometimes some pretty generous reimbursements. I’m not gonna bring some of those up because it’s way beyond what you may are be billing, and I don’t want to entice that. But I’d say on average some pretty good pay. So take a look here for an Aetna patient, this is for three visits.

Three visits with two sets. They’re getting paid $234. It’s not bad. I would take that and the patient only has a $9 copay. Would you think a patient might be interested in that? I would. I think a patient would certainly be interested in coming in if they only to pay a $9 copay for three visits. In other words, three bucks a visit.

Here’s another one for Humana for a single visit, you’ll notice about 67, again, two sets, if there were a third set, probably would be a little bit higher. So would I say these are ones that are viable to you and ones you can directly build? Absolutely. But just be careful. Regular Medicare Part B has not changed.

We’re working on it. When I say we, we as a profession are working on getting acupuncturists fully into the Medicare system that you can register. Then once we can do that, we’ll have direct billing that’s gonna happen that just don’t know how soon, I’ve, I could say two years, five years. I really have no idea.

We have to see if we can get Congress to get together. Vote for a speaker, , and then we can start voting on some real bills. But nonetheless, I think this is a real positive. Think of the number of people who have Medicare now realize 10,000 people per day become Medicare eligible. I would certainly wanna let people know I’m out here.

’cause when you are looking at this type of plan that’s paying you at least a hundred, maybe even as much as 200, would that be something that could boost your office? What if you got five of these per month? And keep in mind with these, you do have to bill insurance. Is that a big deal though? In my opinion, no.

If I have an insurance that I know is gonna pay me, I can figure out how to bill. That’s not that hard. But I’m not gonna accept everything, so I want people that are doing cash. Don’t be beholden thinking because you take one plan. Like for instance, what if you say, Hey Sam, I’ll accept Humana and United, but I don’t take Blue Cross Medicare Advantage.

That’s your choice. Remember your choice to what you wanna bill is there, but keep in mind, it’s your choice. If the patients come in, they probably can have zero or very little copay on these cases, and again, can pay pretty decently. I would say look at what your cash price is. Anything that gets me up equivalent to that, that billing is simple and easy.

I’m all in. ’cause realize all of these plans will have portals where you’ll be able to bill electronically and so long as you do it through their company, it is going to be free. So I say, why not? So be aware. You’re gonna see a lot of this coming up because we’re in the enrollment period. Take a look at the commercials coming up.

They’re promoting your business. Let’s make sure we’re saying, Hey, you know what, we’re here and available here would be the thing though. How does someone know they even have benefits? Have you ever put anything out in your office that says, we accept Medicare or Medicare Advantage? Because otherwise they’re not gonna know.

I still think a lot of people don’t understand there’s even the benefit, so we wanted to start to do things to promotes that people know there’s access, and particularly for the plans, we know that are the good plans. As always, I’m here to help. We do seminars. By the way, what year is it right now?

It’s 2023 Sam, but what updated this month? Diagnosis codes. If you’ve not been to a seminar with me, you have a few coming up. You may want to get there to understand there’s been some coding changes, particularly for migraine headaches. Where will you know how, what fees to charge, the Medicare rates? All of that stuff is something we cover.

We do our network services. Just go over our website. We’re always there to help and I’ll bid you a due. Until next time, everyone, thanks so much. This is Sam Collins and I’m out. . .

Memory and Cognition : Special Points for Treating Chemo Brain

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Hi everybody. Today I would like to lecture on the very interesting topic related to memory and cognition, and especially the effect of acupuncture in reduction of memory and cognition in patients with cancer or patients who are undergoing chemotherapy. And I would like to thank the American Acupuncture Consult, putting up this presentation.

This phenomena of cancer related cognition, impairment, or chemotherapy related cognition impairment are quite known. Sometimes patient describe it as chemo brain or chemo fog, which means they are, have difficulty in concentrating. So different normal tasks, even like reading a newspaper or having memorizing, simple tasks.

Are becoming a chore and becoming a really difficult situation. And it is very, the prevalence is very high. If we see three out of four breast cancer, survivals will say that they had some kind of memory impairment or cognition impairment, and it ranges from 16% to 75. And even more depends on the cancer, depends on the chemotherapy and the length and strength of the chemotherapy.

There’s been few acupuncture studies which are very promising in the result, and they’re very innovative. In the way they look at how acupuncture affects this cognition, one of them look at the effect of acupuncture in breast cancer patients undergoing chemotherapy. It took 80 patients, 40 received acupuncture, 40 were in the control group, and it looked at two parameters.

One was a biomarkers, which is neurochemical peptides, which are released in the brain. The more you have them, they’re called B D N F. The higher the B D N F level in the serum level of the patient, the better cognition, the lower. The worst cognition. So it’s actually looked at the biomarker that you can see objectively the effect of acupuncture versus the control group.

And it took a battery of different tests like assessment of cognition test that the patient had to feel and looked the difference between the patient in the real group comparing to the . patients who were just in the control group and the results were very promising. There’s different things that were different that you could see that statistically are different between the group.

First of all, in the all the tests, the patients who had the acupuncturist scored my higher than the patients in the control group, but also the serum level of B D N F. This biomarkers were much higher in the patients who receive acupuncture comparing . To the control group and when you compare both, there was a good kind of relationship between the higher B D N F level and the higher score in the tests.

So this is showing that this biomarker has significance and potentially it’s another way to understand, or later on to research how acupuncture is affecting the brain and affecting condition cognition. Not just in this group of cancer patients and then going chemotherapy, but generally within the general population and in the control group, there was no significance different on both, not on the B D N F and not on the scoring for the tests.

So the conclusion was that acupuncture therapies an effective treatment for . Chemotherapy related cognition impairment in breast cancer patients, although we need to look deeper into the mechanism and look how the B D N F has affected in this group. When we look at the acupuncture point, it’s quite interesting.

You’ve seen that the group of acupuncture points are concentrated in the head and there is additional points on the leg, like stomach 36. So it affects more in Chinese medicine, we’ll say the spleen, the E. The ability to digest information. Gallbladder 39 will affect the gallbladder, which also and nourishes the brain, but it’s also a point for the marrow, which is reduced during chemotherapy and kidney point and kidney as we know.

And the disease of the kidney is especially important for a long-term memory. So the design was quite interesting. Some point on the head that the fact . Memory and points that affect the postnatal and prenatal chi. Another interesting study was on it’s a very small it’s a kind of very pilot study or initial study, but it was very interesting in the way it was designed and it was in cancer related cognition, impairment in Chinese group gynecological cancer patient.

But the reason I want to bring this study, because they looked already at three parameters. So they look at the assessment like patient has to fill in the forms. They looked also at the micro structural of the white matter in the brain because there is a certain reduction in a certain area in the brain.

When cognition is lowered. So they look at the difference and also in the wide matter itself, in the brain and look at the different neurochemical peptides in the brain, the n a and also in the small group, there was a big difference between control group and between the real, these are the different points, all of them on the head, as you can see.

So it has its advantage and this advantage. And the patient can determine which points he’s choosing according to the patient’s condition. This is example for Tang Point on the head, which can also used for other headaches and other problems in the head when we use it normally in acupuncture. And the results were very interesting because again, there was a better scoring on the test, although the group was very small.

But also there was a difference in this micro structural Side of the brain that is related to cognition, especially the apo colonus and the bdnf. The n a level was also higher, so also this peptide, which you can isolate from the serum was higher. So we are moving into kind of a new era of research, and first, let me say a word about acupuncture and cognition and memory.

In acupuncture, we look at the body, mind, spirit approach. So in the body we, it very much relates to the kidney and to the gene and the strength of the body and the vitality of the body. The stronger the vitality of the body, the better the memory on the mind level. We’ll look at the E, we’ll look at the spleen, we’ll look at the different aspects of ability to think and to assimilate memory and bring things from memory.

But additionally, in Chinese medicine, which is not , Difficult to put in research. We also look at the spirit and Duchenne and the heart, which gives this kind of coherence of cell up awareness and general coherence. Although, we can, when we look into chemotherapy, we need to look also in other aspects of phlegm and toxins.

We can, which we, I will touch on in a minute, a little bit more. So now we are looking at a different paradigm of research. When actually the researchers look at the body of, like in functional MRIs, we look at brain fractures, biomarker pathways, and different neurological system, which are affected by acupuncture.

On the mind. Patients will do the cognition tests and can be compared, but still, hopefully in the future we’ll also give space to something which is more in Chinese medicine, we’ll say, the spirits, the presence, the ability of . Self awareness and being in, in a good awareness, not just in a, for cognition, for tests.

So this integration of Chinese medicine into especially oncology, has a very promising future. I would like to mention that we are doing looking at the, very much at the skills. That acupuncturist needs in order to treat cancer patients. And in the T C M Academy, we’ve developed a very unique and international course, very deep course that looks into the core competence that ones need in order to treat cancer patients.

And as you can see, like cognition and memories is just one aspect. Chinese medicine, especially acupuncture, has been shown . With evidence to help in many other conditions. And when we are looking at teaching the core competence, we are looking at the Western medicine understanding and research. We are looking at the Chinese medicine understanding and also generally we can look at the evidence that are available there and see how we can conclude for evidence.

So in this International Oncology Acupuncture certificate course, We go deeper into understanding this and covering many conditions, especially many conditions, that there is already evidence for them, helping acupuncturists to become a well equipped to treat cancer patients. So we look at different conditions such as pain, nausea, vomiting, fatigue, dry mouth.

And a big list of others in order to equip acupuncturists with the best knowledge and the core best core competence to treat cancer patients. So I hope you enjoyed this presentation. I would like to thank you very much. If you have further questions, you can write to me and all the very best. Be healthy and well.

Thank you very much. . . .

Microneedling for Aging Hands

Today’s lecture is about microneedling the hands, because one of the things that happens as we age, our hands can develop age spots. And the skin itself can lose its elasticity.

Click here to download the transcript.

Hi, my name’s Michelle Gellis and I am an acupuncture physician. Today I will be speaking to you about microneedling for aging hands. So just a little bit about me before we get started. I am a former faculty member and clinic supervisor at the Maryland University of Integrative Health, and I am currently on faculty at Yoan University in California.

And I’ve been teaching facial and cosmetic acupuncture classes since 2005. I have been published several times in the Journal of Chinese Medicine, acupuncture today, and also the acupuncture desk reference. So here are some pictures of me teaching. This was in Sydney and in Sydney, Australia, and in California.

So I do travel and teach internationally.

The first thing I wanna speak to you about is microneedling. I mentioned that I teach cosmetic. . And facial acupuncture classes. Neuromuscular conditions. Cosmetic conditions. So why would you want to, might, why might you want to think about adding microneedling into your. Cosmetic acupuncture practice or into your practice at all?

Microneedling is an alternative to surgery and it can address things skin level conditions such as fine lines, acne scars, loose skin, enlarged pores crow’s feet, lip wrinkles. Dark spots and even stretch marks on the body and can be very beneficial for hair restoration. And that can be head hair eyebrow hair, even empty spots if you have a beard.

So how does this work? What does it do? It helps to stimulate your body’s own collagen production and any products that you put on your skin like serum, it will help to increase the absorption of those products by up to a thousand percent. And all of this is clinically . Proven there have been hundreds and hundreds of studies on microneedling and its effectiveness for hair growth, stimulating collagen, treating scars, and increasing product absorption.

The benefits of microneedling are that there is very little downtime, unlike some other . Cosmetic procedures like lasers or surgery, there’s very little downtime. There’s very low risk. It is extremely effective and it can, as I mentioned, help to boost the natural collagen production in the body. It’s very comfortable.

Most people don’t need any numbing cream. But it, the process itself is quick, it’s comfortable, and the results can last up to five years. So here is a cross-section of skin. So this is what a piece of skin looks like, and here we have the epidermis, and then we have the dermal layer. And then below that we have the subcutaneous later layers.

So when you’re doing microneedling, you’re only affecting, all you need to affect is the epidermis. And here is a cross-section of the epidermis. And this very top layer is called the stratum corneum. And this is . The way that skin reproduces is, it starts at the bottom and then all the new good cells work their way up.

And this top layer flakes off. So microneedling when you’re microneedling, you have two different types of tips you can use on the pen. And I’ll talk about those in a minute. But one type just sloughs off the sh stratum corneum. And then the other type will go a little deeper down into the epidermis and we’ll get right into the base layer of the epidermis, which is this stratum based saw layer.

And that is where the new . Healthy skin cells get produced and by needling down through these upper layers, you will create new healthy skin cells more quickly. And this helps with wrinkles, the dark spots, and can even tighten the skin up a little bit. If your skin is . Sagging. It used to be believed that you had to go down into the dermal layer here and this can be very painful and there can be a lot of bleeding.

But what they have found in the past couple of years is you really don’t need to go that deep in order to . Affect these new fibroblasts, these new skin cells to be created. So this is what a cross-section might look like of the microneedles going down into that epidermis. And when these very sharp needles just puncture the epidermis, they go up and down very quickly and they create

They stimulate new stem cells and also fibroblasts. And this helps with things like scars and wrinkles, discoloration, and the other things that we. Mentioned, so it looks like this. You have your piece of skin, maybe this is a wrinkle or a scar, and you poke little holes into the epidermis.

You get new arterial and venous capillaries and the fibroblasts, and they all come together to form these new collagen fibers, which makes your skin look smooth and healthy and youthful. Another benefit of microneedling is it helps with the endothelial cells inside your capillaries and blood vessels, so this can help with things.

Like spider veins, it can increase the blood supply to the scalp. So this helps your scalp to be more healthy. And in addition to your products getting absorbed and exfoliating the all of the old sebum that can build up on your scalp, it helps the blood supply to the hair follicles, which helps your hair follicles to stay healthy, and it helps the little hairs to poke out.

So this is a picture of a microneedle pen, and we have a little bird joining us for today’s webinar. So I have a microneedle pen here and I’m gonna show this to you really quickly. If we can go to meet. Thank you. We can go to me. They are . Package like this, and then this end, you can plug in if you want to, or you can screw the plugin end off.

And it comes with two batteries and the batteries screw on like this, and then you would put the tip. So this is a needle tip. . And if you just, if you press, let’s see, where am I going? If you press on the end, you could see the little needles poking out. So what happens when you put the tip on the pen?

You click it on nice and tight, and then you turn the pen on

and it will. You see the numbers changing and the higher the number, the faster the little needles will go up and down. They’re moving in and out. And then you can also adjust the height right here. That’s my little adjustment. You can height you can adjust the height of the needles, and this determines how deep the needles will go in.

And the other type of tip I’m just gonna show you while you have me on full screen is called a nano needle. And as you can see, the needles are very tiny. You can hardly see them. They are like little tiny cones. And those are used for the red part of the lip. Inside the orbital rim areas that you normally would not want to needle.

Okay. We can go back to the slides. Today’s lecture is about microneedling the hands, because one of the things that happens as we age, our hands can develop age spots. And the skin itself can lose its elasticity. So when you pull on the skin on the back of the hands, it doesn’t snap back and it can look saggy.

And also the veins on the back of the hand can become very prominent. And I noticed this on myself as I was getting older. I’m 62 now and I was really becoming conscious of what the back of my hands looked like. And I used to derma roll them. But once I started microneedling and the microneedle pen that I showed you is made by AccuLift and there are a lot of great

Microneedle pens out there. So I strongly recommend we don’t have time today to talk about microneedle pens, but I strongly recommend doing your research about pens. But I started microneedling the back of my hands and it really helped with any dark spots and veins. And I was very happy that Really faded out the dark spots and helped my hands to look really youthful because most people focus on their face or their neck, but they’re not thinking so much back of their about their hands.

Now there are special concerns though when you are talking about the hands, and that is the hands are very bony. The veins can be very close to the surface. They can be very sensitive, especially when you’re microneedling on bone and because the fingers and the hands do not have as much blood circulation as other parts of the body.

especially in the elderly, the healing capacity can be reduced. So these are things you have to think about when you’re going to be microneedling the hands.

Also you, even if you’re just microneedling someone’s hands, let’s say they’re coming for cosmetic acupuncture, you do the cosmetic acupuncture on their face, and you wanna do some microneedling on the back of their hands, you want to make certain that you inquire about all of your usual contraindications, things like steroids.

Blood thinners, any prescriptions they might be on. And then after they have their . Procedure, their treatment that they use sunscreen on the back of their hands because our hands, we always think, oh, sunscreen, I’m gonna put sunscreen on my face. But we don’t always think about the back of our hands.

And then we’re driving, we’re biking, we’re golfing, we’re playing tennis, and our hands can be exposed to the sun just as often as our face. So the protocol. And again, this is just an overview. This is by no means in-depth training. If you want an in-depth training, you can go to my website facial acupuncture classes.com, and I go through a full microneedling training.

But just as an overview, the patient would wash their hands. You need to wear gloves. You can apply numbing cream if they’d like it, and that it needs to stay for about 20 minutes. Then the numbing cream comes off. You can use a cotton pad with alcohol on it or even some makeup remover with alcohol on it.

And, Definitely wipe the back of their hands with alcohol. Then you’re going to apply your treatment serum, usually a hyaluronic acid, and then you are going to adjust the pen height and needle depth according to the directions. And normally the technique with the pen is just up and down. You’re not gonna wanna go left to because you’ll be going over.

You’d be going over tendons and you don’t wanna do that. So it’s up and down when you’re on the hands. And then you might use a stamping motion if they have any spots, and you might get a little pinpoint bleeding, but that’s okay. It’s perfectly fine. You just. Go through that. And then if there’s any prominent veins, you want to go gently over those if they have any veins on the back of their hands.

So here’s an example of someone that I did. I. Just a couple of treatments on and you can see that hopefully you can see better there. This one spot in particular really faded tremendously and this had bothered her quite a bit. And little bit more collagen starting to form after just a couple of treatments.

So the treatments are spread out once a month. And normally four to six treatments is what is required. And if you want more information about microneedling training, I do live classes. And my schedule is at fa facial acupuncture classes.com. And you can also follow me on my social. It’s . You can just find me at Michelle Gillis and I have a facial acupuncture Facebook group as well.

I’m on all forms of social media under Michelle Gillis. Thank you so much and thank you to the American Acupuncture Council for hosting this. .

Top 3 Things to Never Say When Networking

Today we’re going to be diving into one of my favorite topics because it’s the most heavily asked thing that people come to me about is networking.

Click here to download the transcript.

I am Dr. Nell with American Acupuncture Council, and welcome to another episode of To The Point. Let’s go to the slides. Today we’re going to be diving into one of my favorite topics because it’s the most heavily asked thing that people come to me about is networking. And we’re gonna go specifically over things that you do not want to say when you’re networking.

Things that could be damaging could prevent you from accomplishing what you wanna accomplish when you’re either . Networking with other providers, trying to get referrals, trying to build more people in your community. And so we wanna make sure that we’re not doing these three things that we’re gonna go over today to get the most value out of that experience.

First, let’s just address something real quick. Why do we get this wrong? Those harsh truths when it comes to why are we saying potentially the wrong things when we’re engaging in something like networking? First of all, we’re human, so let’s acknowledge that we’re not gonna get things right every single time.

But a lot of times when it comes to networking in general, the issue is we’re so focused on our needs and not about providing value for the person that we’re talking to. So we can be selfish by nature. A lot of times when people think about going to a networking event, they’re thinking, oh I’m going here so I can get more patients or, so I can find more referrals or, so I can meet somebody who’s gonna be part of my care team.

. A lot of times we’re focused on, yeah, what is the bottom line for us, rather than what is the value that we can provide? And then of course there’s a fear component, right? Again, that goes back to we’re all human. Fear of, I don’t know exactly what to say if I’m too forthcoming with why I’m going to this networking event, how is that gonna come off?

Am I ? Going to feel confident enough to accomplish my goals when it comes to talking to complete strangers, that’s not an easy thing to do by any means, and it’s something that does require a little bit of practice. So what I wanted to do with this presentation really nice and quick today and value driven is just go over.

The commonly heard things that don’t provide a lot of value for people. The biggest one that I hear, and I’m gonna put it first, is people say, I want to pick your brain. This is one of the most. Common things that will come out of somebody’s mouth when they go to an event. When they call up somebody as a follow-up.

I get this all the time, people I know a lot or don’t know very well. Now granted, if you know somebody really well, you have an established relationship with them. Let’s say you’re a former student of mine that I’ve met several times, I don’t mind someone saying, I wanna pick your brain. The mistake that gets made however, is, we are excited to meet someone.

We admire that person. We feel like they would provide a lot of value for us, and then we shoot them an email to try to set up a meeting and we say, I wanna pick your brain. The reason that this is problematic is, First of all, there’s an assumption here that person values their ego more than their time, right?

So you’re telling them, oh, they have something to offer, and just assuming that they’re gonna give up their time in order to share that with you. So it’s not a value driven statement to make. So we wanna do something else. We wanna shift the focus so it’s more value driven for them, something that we can provide, something that we wanna share.

Being more specific about what we wanna talk about, saying to them. You know that they’re the person who could answer X question for you and you’re going to do X, Y, and Z. That doesn’t mean that everything has to be transactional. Really, though, we just wanna make sure that we’re providing value anytime we speak to somebody.

And so you never wanna say to a perfect stranger, oh hey, I wanna pick your brain, and just assume that they’re going to be able to make time for that or want to make time for that. The second thing that I hear a lot is whenever you have time, This goes a little bit into that third piece, that fear component that someone would say no to us.

Not wanna hop on a call with us, not wanna have a follow-up conversation to one that we had when we are unspecific like this and say whenever you have time Everybody feels like they’re busy and they don’t have time. So we wanna shift this a little bit to say when you can make time, when it’s convenient for you give them specific times in the next week or so.

I’m available Tuesday through Thursday at these times. People do need guidance and you wanna make this process as . Easy for someone as possible. So if I get an email from someone and they say, Hey, I wanna pick your brain whenever you have time. To me that ends up being a lower value email. It’s one of the last things I’m gonna get back to because I have all of these more specific requests from people.

I think generally people do wanna help. They do wanna engage, they want to cultivate community and cultivate relationships. But it can be really difficult in the society that we live in the day and age that we live in where people are generally very busy and they need a little bit more specificity and a little more guidance as to what that ask is.

And this one I put in very specific for our industry because as much as . I love the acupuncture community. I love our profession. We have a tendency to engage in medical jargon. And when I say medical jargon, part of that tradition that we hold so dear in our medicine, things like. Chi Blood Yin.

We’re so eager to talk about how we can help people. We’re so eager to educate about how incredible and effective our medicine is that sometimes we tend to. Overwhelm people with information and overwhelm people with information that is not particularly valuable to them or relevant to them at face value.

So if I’m someone who’s never heard of this medicine before and you’re talking to me about chi or blood, I might have an idea of what I think blood is. And that’s very different than what we mean about blood from a clinical perspective. So when we’re trying to . Cultivate a relationship with someone or provide value to someone.

We wanna make sure that we’re meeting them where they’re at. So if someone is a very busy, stressed out business person and we’re talking about how we can provide them value rather than talking about cheese stagnation that they may be having, we wanna talk about stress relief better sleep, things that are gonna be a little bit more relatable to them.

So at the end of the day, the things we wanna remember, ’cause we’re going back to the don’ts. Why we don’t do this right all the time. Yes, we’re all human. So that is the truth. Whether, we’re saying something like, I wanna pick your brain. Just think if you would wanna hear something like that.

Or whenever you have time. . Not specific enough for me or the person that I’m talking to. So you wanna remember that? Yes, we’re all human, but you wanna first and foremost focus on the needs of the person that you’re trying to reach, that you want to take time out of their day to have a conversation with you, to network with you, to build a relationship with you and.

Let’s get rid of the fears because if you are coming from a good wholehearted place, if you’re coming from a place of wanting to provide value, there is never any reason to fear that connection with someone, that conversation, or that desire to build your network. So again, I told you it was gonna be nice and quick and value driven.

If you have any questions for me, you can always reach out. I’m at the American Acupuncture Council and be sure to tune in next week for another episode of To the Point. .

Facial Acupressure for Health and Wellness

…when we think about health and we think about wellness and Chinese medicine, we think about yin and yang, cheap blood fluids, the meridian system and the organ systems.

Click here to download the transcript.

Hi, my name is Shellie Goldstein, Dr. Shellie Goldstein. Welcome to the American Acupuncture Council. Today’s presentation is Facial Acupuncture for health and Wellness. I am specialist in cosmetic facial acupuncture, but today we’re gonna talk about health and wellness because they are com overlap and they interlink.

So let’s get started. Let’s start with the PowerPoint presentation.

Most of us know who are acupuncturists, that when we think about health and we think about wellness and Chinese medicine, we think about yin and yang, cheap blood fluids, the meridian system and the organ systems. As a specialist in cosmetic facial acupuncture, what I love about treating

The body and treating the face is the correlation between the face and the rest of the body. We know that we have meridians running up and down the body. We know that we are affected by the state of health of our organ systems. We also know that all of the young meridians. Either start or end on the face.

What we may or may not remember is when you think about the organ systems, each of those systems has a sense system. Now, whether it be the eyes, the nose, the ears, the mouth, meaning, What we see, what we smell, what we hear, what we taste, and they affect and are affected by the state of health of each of the organ systems and the meridians, because remembering that the meridians run through the different organs, assume their name and pick up the characteristics of that.

System, that organ system. But then again, the meridians affect the organs as well. So we know it’s that yin y balance, that the complimentary dynamics between the meridians and the organ systems and the health of our body. But also remember that when you see things, when you hear things, when you smell things, when you taste things, it creates a sensory stimulation, some type of proprioception where we are in the world, but also.

Not just on a physical level, but on an emotional and energetic level as well. So when we surround ourselves with beautiful things visually, we feel relaxed, we feel at peace. As opposed to when we see something that’s awful or horrifying or frightening, then those emotions get reflected in the body as well.

The same with our, or with our sense of hearing. If we hear soft music, like we heard as we were starting the live stream of this presentation, it’s very soothing music. It’s very lovely and it brings peace and harmony within as opposed to seeing, hearing something loud, abrasive, shocking. Disturbing. It sets up that a different dynamic within the body as well.

Same with smell, same with taste. So the emotional activity that gets triggered when we experience something is very much a part of the reflection of what’s going on inside and reflects in terms of affecting how we are. Feelings, feeling both on a physical and emotional and a spiritual level. So in that sense, the face is a very important part of the diagnostic and treatment of health and wellness.

So we can diagnose what’s going on in the body by looking at the face, because remembering that our muscles are tissue. Interstitial tissue, the connective tissue, all of the different aspects of the layering from skin to bone holds that memory, particularly the connective tissue holds the memory of that experience.

If we process that experience and let it go, then it let’s go in the connective tissue of the di of the face. When we hold onto that experience, that also gets reflected in the face. And so we can look at the face as an big organ, one big facial organ map. And when we look at different parts of the face, each of those organ systems are reflected.

For example the forehead and the eye. Browse is related to the liver and the gallbladder system. The spleen and the pancreas is the eyelids and across the bridge of the nose the kidneys run underneath the eyes and on the chin and the ears. The lungs are the cheeks. The heart is the tip of the nose and the stomach and the intestines is, and the reproductive organs are around.

The mouth and what that means is that disharmony in those organ systems is reflected in the face, whether it be in terms of wrinkles tissue sagging skin disharmonies, acne, rosacea, breakouts, or just red pitted skin rosacea. Any disharmony on the surface of the skin or in the deeper layers of the skin is reflected by the organ systems and a reflection of the organ systems in turn of their health and wellbeing.

And then when there’s a disharmony in the organ systems, it is reflected and pass through. The different meridians. So what’s nice about treating the face is that it’s a wonderful tool and an opportunity to both diagnose what’s going on in the body, but also to treat, because as we treat the face, we have an effect on the state of the lungs, the state of the liver, the state of the spleen, the state of the heart, the state of the kidneys.

And we can harmonize both from a meridian’s perspective, but also from an organ. System, we can make a difference just by treating the face. Now, we know from our cosmetic acupuncture world that we’re not when we treat wrinkles, when we treat sagging skin, when we treat different skin conditions, we’re not just treating the surface of the skin, but we’re treating from within as well.

And that means that when we treat. For cosmetic facial acupuncture or for health and healing. We don’t just put points in the face, of course not. What we’re gonna do is we are going to do our diagnostics, tongue pulse pattern of is harmony, and then we’re gonna treat accordingly and we’re going to use the face as a treatment, as a diagnostic tool and a validation of what we find when we do our tongue pulled and questions.

So what I would like to do today is help you to understand how to treat the face by going through a very simple facial exercise. It’s an acupressure exercise, so it’s something that you can do at home. It’s something that you can . Do on yourself. It’s something that you can do with your patient and acupressure.

We know that acupuncture and acupressure are both ancient healing techniques that have been acknowledged for their effectiveness by both Western medicine and eastern medicine, and supported by thousands of scientific studies around the world. We know that acupressure and acupuncture are based on the same fundamental principles of acupuncture point activation across all of the meridians.

We know that acupressure is basically pressure applied with the hand fingers or an instrument assisted device at specific acupuncture points to adjust and balance the flow of energy. And the National Institute of Health Database offers hundreds of studies on the use of acupressure in the treatment of dozens of conditions, including a allergies, chronic fatigue, constipation, insomnia, musculoskeletal disorders, heart disease, pain, and stroke.

And we know as acupuncturist, there are many more health issues that acupuncture and acupressure treat. I wrote a book in 2016 called Your Best Face. Now look Younger in 20 Days with a Do It Yourself Acupressure facelift. And I also created the Touch and Glow Acupuncture assisted. It’s an acupressure assisted tool.

In my book, I outline a number of different techniques for facial harmony. But also for health and body. And the acupressure technique that we’re gonna learn now is based on some of the systems or some of the parts of the book that, that I wrote and the photographs that I took for the book.

So let’s get started. Let’s just have you sit back, relax, take breath. And relax, blow out. Exhale. Let’s lift your shoulders up. Drop them. Lift your shoulders up, drop them. Rotate your neck.

And stretch it out. And I’m actually gonna lift my glasses up so you can see my face, because I’m going to walk you through an acupressure technique that is going to improve health and wellness of not just your face, but your body as well. It’s very relaxing and I think that you’ll enjoy it. So let’s start by opening the neck.

I’m going to. Place my fingers at the top of the Ss c m. So if you go to the jaw area and slide your fingers up to the top of the neck to where the cervical, where the skull meets the cervical vertebra. And slide forward to the top of the Ss c m, the sternum Plato mastoid muscle. And then we’re just gonna massage down the Ss c m to the clavicle.

I just massage. Now I’m gonna do it five to 10 times. And in doing so, what we’re doing is not only we’re relaxing the neck, but we’re also helping to reduce tissue inflammation by improving lymphatic drainage, which means that if you have allergies or if you have any type of congestion in this area, what you’re gonna do is you’re gonna feel that coming down in the form of kind of a saliva on your throat, you may need to swallow good.

Okay, now take your fingers, go behind your neck, and you’re just, you’re gonna take these four fingers and you are going to place them starting at Bladder 12 T, nsu, and Gallbladder 20 Thank Chi and Andon. If you don’t exactly know where they are, it’s okay. Just place your fingers at the base of your oput on the outer, outside of the spine.

And feel for areas that are tight and just gently massage these points with the pressure that feels comfortable for you. And it doesn’t matter if you go clockwise or counterclockwise. Just massage those points five to 10 times good. Make sure that you breathe good, right? Excellent. And now slide your finger to what we call triple heater 17 or yen.

Yen is where the star is on the image. So you you have the corner of the jaw and the lower aspect of the ear lobe. It’s in between the corner of the jaw, directly under the ear lobe. We’re gonna massage this area. This point is the access point to the facial nerve. So the facial nerve is the nerve, the motor nerve that innervates the entire face and controls all the muscle activity on the face.

So by massaging this point, not only does it improve lymph drainage, but it also helps just to relax all of the muscles of the face. Okay. And now with this point we’re going to take our fingers and keep your finger on this point on Triple eight 17. And then just massage up and down the front of the ear.

So we’re covering Teen Quo, teen Gong and Erman Gall butter two small Intestine 19 and heater.

And then slide your fingers around the back of your ear, back to triple heat 17. Massage triple heater 17 again, and continue to massage up and down the ear in front of the ear

about five times, 10 times, and slide your fingers behind your ears again. Let’s do that one more time. Massaging triple leader 17, and then up and down the front of the ear

and behind the ear. Great, and now let’s slide up to T Young T. Is located in the temples at the end of the eye area. You massage that area. So this is great for any type of stress around the eyes and the face.

And then we’re gonna treat The three points on top of the eyebrow, , and sanju. So again, you can do it with your three fingers. 1, 2, 3, and just place them at the end of the eyebrow, the center of the eyebrow and the middle of the eyebrow at the inner campus of the eyebrow sort a massage.

Good.

And big relaxing breath. And now we’re gonna go to our favorite point. It’s yin tongue and we know that yang is the main point for relaxing the body, mind, and the spirit. We don’t do this for about five to 10 times.

And move into the inner aspect of the inside of the corner of the eye to bladder one. And again, this point is used for any type of eye disorder, which we know affects the liver system, and it’s used to relax and open and brighten the eyes. And then we can stomach one and stomach two, or right on top of each other, above and below the orbital bone.

So use the flat part of your finger to capture both of them

and just massage ching cheese. See by feel relaxing.

And then back to

and let’s repeat that sequence again. Oops, sorry. We’re gonna go back up to the eyebrows, the top of the eyebrows.

End tone.

Water one.

Stomach one and stomach two.

Cool. And this time we’re gonna slide down the nose. To lateral to the side. Yeah. Lateral to the side of the nose, and we’re going to type. Stomach. Three is underneath the eyes, lateral to the side of the nose, small intestine. 18 is at the outer canthus of the eye, lateral to stomach three. And then stomach seven is lateral to that in front of the ear, and we’re just gonna massage his points.

Three fingers, just massage his points.

Good. Don’t forget to breathe.

And then slide down to stomach four. Deep tongue. It’s at the corner of the mouth.

We use this point a lot in facial acupuncture. It is the connection to all of the muscles of the face that connect from the mouth to the eyes and to the collar. Very important point. And then take your thumb. Place your thumb underneath your jaw. And then the top and the fingers, the first four fingers, and then just slide out to stomach six stomach sixes.

I use it the corner of the jaw. The angle of the jaw. We’re gonna slide, slide,

slide. And then come back. Come back to the S C M

and slide down to the clavicle.

Now let’s repeat that again. I won’t talk this much. So again, ing your fingers. See on Zoom,

Andon

circling around feeling for those tight areas

and then slide to offense directly into the.

And then massaging

ting gong air mine, and slide behind your ears. Come back to triple heat. 17.

Slide up and down in front of the ears. At this point, you should start feeling new, smooth, relaxed. It’s a great, this combination around the ear is really good. If you can’t sleep at night, great. Insomnia. It’s really relaxing, super smoothing,

and up to nne, massaging, nne.

It carries so much stress in our eyes

and then coming back.

Nice. Get that little extra massage.

Let’s do that one more time. Slide up.

Under the. I wanna use a little lighter pressure under the eyes

tie.

Now to get there, we’re gonna come down. Slide around the corner. Angle of the nose, fingers. Inner canus of the eye. Center of the eye. Center of the eye, outer campus of the eye. And in front of the ear massage

do come.

And thumb under the chin fingers slide out to stomach six, which I g.

And then back down the.

Feel better. I do. So this, again, this is a great short treatment that you can give yourself, you can, and help your patients by showing this to them. It’s very simple, very effective. And I hope you have a nice day. So thank you very much. If you want to learn more about me, you can visit me@hamptonsacupuncture.com or follow me on Instagram.

Again, my name is Shellie Goldstein. I also teach a number of classes through the Pacific College of Health. And we have a symposium coming up. So thank you very much, and again, thank you to the American Acupuncture Council. For having me here today, and I hope you have a lovely, relaxing, peaceful, healthy day.

Thank you. .

Does Your Documentation Match Your Services?

Click here to download the transcript.

Hi, everyone. Welcome back in. Thank you, American Acupuncture Council. Let’s make sure the profession continues to understand its growth and its potential. One of the issues I deal with a lot is documentation and coming from being the acupuncture coding and billing expert, I get this lots of times.

I recently had a call from a special investigator. From the Department of Banking and Insurance in New Jersey, I’ve dealt with this in Florida, California, and frankly all over to some extent, and it’s about documentation of acupuncture. Now, frankly, I don’t care whether you’re billing insurance, you’re doing cash, doing a combination, you still have to have your information documented.

It’s not very hard, but what you may have learned has been updated. And one thing to keep in mind, acupuncture is a profession. It’s not a perfect meaning, it’s a practice. You’re always learning and updating and one of the things you have to keep in mind is things have updated and I think there’s a lot of misinformation when it comes to acupuncture documentation, which I will go back and say, not very hard, it’s what you do, but have you ever really thought about what does it require that I have to have down?

Whether you agree or disagree with some of the aspects, frankly doesn’t matter. ’cause we have to go back with what is the standards set aside by law. And of course the profession itself. So let’s go to the slides. Let’s talk about Accu Acupuncture documentation, and let’s talk from it this way. We want to assure your documentation simply matches the services performed.

What if a patient makes a complaint that you didn’t, you charged them too much for the services they did. This is cash, and your notes have to back up what you’ve done, or it’s an insurance or any aspect in that way. So don’t be cavalier thinking that, oh, I don’t take insurance. I don’t have to document.

Not at all. I. Your liability is such that if you didn’t document what you have performed on that patient, it didn’t happen. So let’s assure documentation matches the services performed. Here’s one of these insurance claims that I get. A lot of these, because obviously people are billing insurance. It pays well in a lot of aspects, but you get back saying, we’ve looked at your notes and they weren’t well done.

Now, some of you may know I’m actually on the board. Or what’s called the Coding and Reimbursement Committee for Optum Health in United Healthcare. That doesn’t mean I work for them, by the way. It just means I’m an appointed member that oversees things. And one of the things we commonly run into that are problem for acupuncturists is just improper documentation.

In fact, in many ways, acupuncturists for documentation are low hanging fruit because often it’s never been learned or taught. How to properly document. So take a look here. What does it say? This office is billed out an initial set of acupuncture and it says the information submitted. This means your chart notes is, does not contain sufficient detail.

The submitted records don’t support. 9 7 8 1 0 was performed. It goes on to say it for the second set. Claim cannot be processed as billed. The code requires a proceeding procedure code, which means this one, and it’s not supported. We see this time and time again, not just with acupuncture. Here’s some more of that.

The documentation does not support the services billed. In other words, if you’ve collected money for something, you have to make sure you’ve shown you’ve done it in a way. This is a receipt, if you think of it, your documentation is a story, but a receipt or indication of what was done on the visit and the results of it.

So over and over we see this. Investigational services, but notice here, services not rendered as billed. Just simply documentation. Take a look here for 9 7 8 1 1. What it says is the each additional 15 minutes of one-on-one service, there are multiple examples where there’s conflicting information with respect to the time spent with the patient, and in fact, notice this one, 42% of the claim lines had no supporting documentation.

Just writing a date and saying they had acupuncture is not sufficient. Again, I want to emphasize, This is not about insurance, it’s about what’s documented about your patient, what was provided. So let’s take a look. What does it say in C P T? What do we have? Now? Keep in mind these codes have been in place for 20, or excuse me, 18 years, ’cause it’s 2023 and they’ve been in place for 18 years.

When I see people not understanding this, it frustrates me. ’cause I’m thinking when did you graduate in the seventies? So take a look. It says acupuncture, one or more needles. So what does acupuncture require? You insert needles if you don’t put needles in. It’s not acupuncture in the sense of a billing code or a service, so you have to put needles in, and then it says, With one-on-one time.

In order to put the needles in, you have to spend time with the patient. And acupuncture codes, as I’m sure you’re well aware, indicate 15 minutes and you’ll see this time and time again. The initial set needles in 15 minutes, the additional set needles in 15 minutes. So this is not unique, it is not new, but it’s something we have to make sure that we have.

So again, taking a look, needles time and needles. Now I think we’re often, we get confused is do I actually have to write the time down? Yes. If you are doing a service that is time dependent, there has to be time somewhere. Now, here’s the good news for the profession. Acupuncturists, I would say in my experience, and I’ve been around this 25 plus years, probably spend more time with their patients.

I. Most other providers, partly because the service you provide is very specific for time and things you’re doing, but also because of the things you have to evaluate, realize all of that is included. So what I want you to think of is what time am I documenting? Literally, if you’re doing acupuncture that day, the time starts as soon as you walk in the room and say, hi, Mrs.

Jones, how are you? It starts. So you’ll see here it says, how is the 15 minutes of time defined? Let’s make that larger so it’s easy to see. The 15 minutes of time for acupuncture includes lots of things. Basically everything you do when you contact the patient soon as you walk in. This would include a review of the history, so you know when you walk with room and say, Hey, how are you feeling?

Is it better today or worse? What’s happened over the last few days? That time counts towards acupuncture. It includes your day-to-day evaluation. Some of you may do tongue and pulse. Some might do range of motion. You might do some other testing. That’s all fine. It’s included your day-to-day. How is it feeling?

How is it better or worse? Notice, hand washing, sanitizing your hands, choosing and cleaning the points, quite frankly. Opening the needles, getting them ready to be put in the patient. All of that counts as well as the time it takes to insert the needles, making sure they have good grasp. You’re in the right point, making sure it’s all good.

Actually asking the patient how that feels would include. So that includes inserting, manipulating. Now, what doesn’t count is once you’ve put the needles in and the patient’s just laying there to rest without any interaction, that would not be considered part of it. But let’s say the patient is on the needles, but while they’re on the needles, you’re manipulating them.

That would count, but what also counts is the time that you’re in the room, again, removing the needles. Including notice here, completion of chart notes. So removing disposal. So I want to keep in mind time, just tell me when you’re in the room with a patient doing anything that’s part of acupuncture.

Now an exam is separate or if you’re doing another therapy, but the majority of what an acupuncturist is providing a course is acupuncture. Tell me the time. The only thing that really doesn’t count outside of the exams and therapies is the time the needle are retained. Isn’t included because that’s not something you’re time dependent by example.

Not unusual. I know the acupuncturist I’ve been to often I’ll have neuros needles inserted and I’ll lay there 10 or 15 minutes relaxing, maybe listen to some soft music or something of that nature. Nonetheless, that time doesn’t count. So here’s what we have to document. Don’t make this hard document the time and the needle.

So here’s two examples to, and I’m gonna give you a couple of examples to try to give you a feel for what you want. Now realize . There’s gonna be many ways you might do this, but it’s gonna fall somewhere in this range. Notice here it says clearly treatment or needle set one. I would prefer that you indicate which one is set, one or two.

If you’re doing multiple sets, say it. Say this is set one notice here. It’s indicates face-to-face time. So here it says 20 minutes and it says what needles or what points were needled. It lists all of them. And notice it actually indicates there was estim added to these two points, U B 62 and G B 34.

So that means that this set, because there’s electricity at it, becomes an electrical set. Nothing more complicated. It doesn’t have to be every needle, just even two. So notice what it does time. Points. Notice, it does indicate, Hey, the patient was rested on needles for 12 minutes. That’s fine. Now what if you just stay in the room with the patient and you’re continuously needling?

That’s all face-to-face. We just have to decide what’s points were in the first 15 and second 15, but nonetheless, showing here time and needles. Not complicated. Get in that habit. Notice it says here, after the patient rested with needles, they were withdrew and repositioned. Now let’s keep in mind, do you actually have to withdraw the needles?

I. To insert a second set. No. You may or may not. I’m not gonna say one way is better or otherwise. Obviously, I guess if one is a front side set and one’s a backside and they’re laying face down, face up, probably, but outside of that, no. They don’t necessarily have to be removed. In fact, commonly when I’ve been in, and I can again leave my own experience, I’ve had needles inserted and then just additional ones were put in, that would be a second set as well.

But notice how it’s documented. Treatment set two. Face-to-face. Time on this one is 18 minutes. What points did we needle notice? They added some ones with electricity. So clearly. Was there enough time for set one and set two with the points documented? Absolutely. So start thinking of how am I gonna do this?

Whether you’re doing paper notes, electronic notes, simply tell me your time in the room, face-to-face with a patient doing something that’s part of your acupuncture, along with the points you’ve inserted. Not very hard. Now you may question what about time? I did a program on that. If you’re not familiar with the 15 minute and the eight minute rule, go back in the R archive.

We have that listed there. But here I just wanted to make sure. Notice how simple that is. Don’t overcomplicate that. What you don’t wanna do is say I needle the following points and say I spent 30 minutes. Because if I do that, am I dividing into two sets? Make sure that it’s clear that what needles were in setted for set one or set two, or during that period of time.

Here’s another example. Now this is a full chart note. You take a look at that, but I wanna focus on just the documentation of the acupuncture. Notice what this one does. Pretty much the same thing, but just done slightly different. Notice it says each set of acupuncture is set one, two, and three.

It says the points that were inserted or reinserted. So it’s real clear that there were needles inserted. It tells you the face-to-face time, and if there’s separate retention, it does it. So notice this one. It names three points, the time spent. Now you might think we’ll see ’em. Come on. It wouldn’t take me 25 minutes to insert three needles.

You may think so, but realize the insertion of needles is not just the physical time of inserting the needles. All the things that you do with the patient to determine where you’re gonna put those points. The time to clean your hands, put the needles in, make sure there’s good grasp, realize all of that counts, including, let’s say, when you come back in the room, I.

To remove them. So notice each set clearly set aside for each one and time. Now, notice the other one said it spent 18 minutes or 20 minutes. Notice this one says, from, and two, frankly, it doesn’t matter according to C P T and the standards. So long as you indicate whether it’s minutes or from, and two time, it’s acceptable.

Just make sure it matches what was billed. So I’ll say to you, don’t overcomplicate this. Don’t be confused because well, in school I was told this or that. Again, sometimes what you were taught in school may have been old information. Or let’s face it, we all have biases. So what if you had an instruction that goes I disagree with it.

I will tell you, I don’t necessarily have an issue with someone agreeing or disagreeing, but I do have to go by what does the law and the rule state. So long as you’re within that. This is not hard. In fact, I would say to most acupuncturists, the one thing that I think most acupuncturists take pride in is the amount of time you spend with your patients.

Document it. It has value. You’re inserting needles. It all counts. We’re here to help realize, this is what I do on a day-to-day basis, is helping offices deal with problems to say, let’s take a look at your notes. Let’s make sure they’re okay. That’s what we do with our network members. If you’ve not been familiar with it, take a look.

Also note, we have seminars upcoming coming soon, because remember, October 1st, I C D 10 does update. There’s gonna be some new codes out there that are specific to acupuncture providers, so always know that we’re gonna be your resource. The American Acupuncture Council Network is your place for seminars and for day-to-day help.

Take care everyone. . .