News to Use #198: CPT codes for Kinesio taping, Backing up and restoring customization, Dropping out of the Medicare incentive program, Adding prescriptions, Customizing Prognosis rationale, and lots more.
A word about Kinesio tape from Dr. Marty Kotlar:
Kinesio® taping is a taping technique that is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting the body’s range of motion. Kinesio® taping can help alleviate pain and can facilitate lymphatic drainage by microscopically lifting the skin. It can be applied in hundreds of ways and has the ability to re-educate the neuromuscular system, reduce inflammation, enhance performance, prevent injury and promote good circulation and healing, and assist in returning the body to homeostasis.
According to the AMA, “Kinesio® tape is a supply. Its application is included in the time spent in direct contact with a patient to provide either re-education of a muscle and movement or to stabilize one body area to enable improved strength or range of motion. The application of tape is usually performed in conjunction with educating the patient on various functional movement patterns. The tape is applied based on the patient’s specific patterns of weakness or strength. The tape is left in place after instruction related to movements designed for improving strength, range, and coordination is provided and documented. However, if the purpose of the taping is to immobilize the shoulder, then the strapping codes may be appropriate as those codes describe the use of a strap or other reinforced material applied post-fracture or other injury to immobilize the joint. If the taping is performed to facilitate movement by providing support, and the tape is applied specifically to enable less painful use of the shoulder and greater function (i.e., restricting in some movement, facilitating others), application of tape in this manner is typically part of neuromuscular re-education (97112) or therapeutic exercise (97110), depending on the intent and the outcome desired. This includes application of Kinesio® tape or McConnell taping techniques.”
I have not read any insurance carrier policies recently that state it will cover Kinesio® taping for alleviating pain, reducing inflammation, promoting good circulation and returning the body to homeostasis. Therefore, you should consider Kinesio® taping a non-insurance payable procedure. However, if you need to bill an insurance carrier for Kinesio® taping I recommend you use CPT code 97139 (unlisted therapeutic procedure) or CPT code 97799 (unlisted physical medicine/rehabilitation service or procedure). You can also bill HCPCS code A4450 per 18 sq. inches of tape (non waterproof) or A4452 per 18 sq. inches of tape (waterproof).
When reporting an unlisted code to describe a procedure or service, it will be necessary to submit supporting documentation (e.g., procedure report) along with the claim to provide an adequate description of the nature, extent, need for the procedure; and the time, effort, and equipment necessary to provide the service. Please understand that because you can bill for Kinesio® taping, doesn’t necessarily mean it will be reimbursed - sometimes you need to bill just for denial purposes.
Cash or insurance, you need to show "medical necessity" for performing the procedure - this includes an exam, history, making a proper diagnosis, and report frequency and duration of care. The SOAP notes should include the clinical rationale for performing the service and if the functional goals are being reached. You also need to call all the carriers you bill to verify coverage and obtain their policies/guidelines on the procedures prior to billing the insurance company or patient.
We do not recommend you billing CPT codes 29200, 29240, 29260, 29280, 29520, 29530, 29540 or 29799 for Kinesio® taping. In my opinion these Casts and Strapping codes are meant to “immobilize” a joint or body part and are therefore should not be used for Kinesio® taping. Also, we do not recommend you bill CPT codes 97110 or 97112 for Kinesio® taping.
Marty Kotlar, DC, CHCC, CBCS
President, Target Coding
A review about backing up your customization
If you have worked diligently to customize the various features of your E-Z Notes program, it is a good idea to back it up. This is how you do it: From the “Start Screen” go to the “Set Up” button, and on the bottom, you will see a mustard-gold colored button marked “ Send Custom Changes”. When you select it, you will see words crossing the screen, as it builds a file within the E-Z Notes program. You can back this file up, as follows: On your desk top, select the “Start Button” (with Windows 7, it is the Microsoft circle in the bottom left corner) go to “Computer” (or My computer in XP) then Local Disk (C, then find “eznotes, open it and locate a file called, “Shared Customization”. Right click this file and select “Copy”, put a flash drive in the USB port and when shows up on the screen, right click it and select “paste”. Now what was in the folder will be on the flash drive.
After the old computer has crashed and you have installed and updated E-Z Notes on a new computer, put the flash drive in the USB port of that computer, and when the folder shows up on the screen right click and select “Copy”. Now go to Start >Computer > Local Disk (C >eznotes, and paste the “SharedCustom” file that you just copied inside “eznotes”. Now go into the E-Z Notes program >Set Up > and select “Get Custom Changes”. Hit “Save” and restart E-Z Notes and all the information should be back in the program. If this sound tricky call Kim in Tech Support at 408.535.6903 or me 312.212.1602, and we will help.
Medicare, a word about attestation (Dropping Out):
I was asked the question: “If I participated last year in the attestation and received the stimulus money, am I obligated to continue with the program, or can I drop out? I had Michelle in my office check on this and in an e-mail from the CMS dated 9/11/2012 it says: “Eligible Professionals choosing to leave the incentive program may keep any incentive payments prior to leaving, participation is not mandatory. More information can be found here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/
Medicare, a word about adding prescription drugs:
In the section of the certified version where the prescriptions are entered, there is a line marked “Disp Instr” I had suggested that the offices put N/A here. Russ informed me that a better response is “PTID”. This means patient presented ID (identification). Although this does not really mean much to me, you will see that he has created a drop down box with this as a choice, so use it.
Customizing rationale for Prognosis:
When you are finishing a SOAP Note, there is screen that asks about the prognosis, and then a screen that describes essentially why you think that the prognosis is correct. For example, the prognosis is “guarded”, the rationale is that, “it is too early to tell”, or the prognosis is “good” and the rationale is that “the patient is responding well to care”.
You will notice that there are a few customizable buttons where you can add your own “pop in” text. To add something, go to Set UP, and on the upper right hand corner of the “General Setting screen” you will see, “create the text for your own prognosis rationale” (1, 2 and 3). To find buttons 4, 5 and 6, go to “More Reg Visit” and in the middle of the screen under “Change/modify password” you will find them. Here is an example of what you could create: Button Name: “Complicating Factors”, Text: ” has a number of complicating factors”. You could indicate that the prognosis is “difficult to ascertain” (entered using the “Other” button) and the rationale is because, “the patient has a variety of complicating factors”. Have some fun with this if you don’t think the normal options are adequate for a particular patient.
"Move out of your comfort zone.
You can only grow if you are willing to feel awkward and uncomfortable when you try something new."
— Brian Tracy: is a self-help author and motivational speake
"Whenever we're afraid,
it's because we don't know enough. If we understood enough, we would never be afraid."
— Earl Nightingale: was an American motivational speaker and author
"You can't just ask customers what they want and then try to give that to them. By the time you get it built, they'll want something new."
— Steve Jobs: was an American inventor and businessman
More on exercise: http://fitness.mercola.com/sites/fitness/archive/2012/08/31/your-mercolacom-workout-plan.aspx?e_cid=20120831_DNL_artNew_1
Foods for your patients who smoke: http://articles.healthrealizations.com/DesignsRepresentativeForHealthChicagoWesternSuburbs/2012/09/03/Smoke-or-Used-to-Smoke-The-Healthiest-Foods-2.aspx?SubscriberEmailfirstname.lastname@example.org
Is West Nile Virus BS? http://jonrappoport.wordpress.com/2012/08/23/west-nile-theyre-lying-to-you-again/
Info on Section 179 tax break for software etc.: http://section179.org/
Power Plate: http://fitness.mercola.com/sites/fitness/archive/2012/09/07/power-plate-acceleration-training.aspx?e_cid=20120907_DNL_artNew_1
Sprained Ankle: http://outdoors.campmor.com/how-to-treat-an-ankle-injury-and-preventative-measures/?cm_cat=TRAILMAIL&cm_ite=TrailMail-September72012&cm_pla=47714&cm_ven=EMAIL
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How does he do that? http://www.safeshare.tv/w/gdhRWNSrls
Inappropriate Humor (Not particularly offensive)
Oldies but goodies:
From Steven Wright:
1. I'd kill for a Nobel Peace Prize.
2. Borrow money from pessimists – they don't expect it back.
3. Half the people you know are below average.
4. 99% of lawyers give the rest a bad name.
5. 82.7% of all statistics are made up on the spot.
6. A conscience is what hurts when all your other parts feel so good.
7. A clear conscience is usually the sign of a bad memory.
8. If you want the rainbow, you got to put up with the rain.
9. All those who believe in psycho-kinesis, raise my hand.
10. The early bird may get the worm, but the second mouse gets the cheese.
11. I almost had a psychic girlfriend ... but she left me before we met.
12. OK, so what's the speed of dark?
13. How do you tell when you're out of invisible ink?
14. If everything seems to be going well, you have obviously overlooked something.
15. Depression is merely anger without enthusiasm.
16. When everything is coming your way, you're in the wrong lane.
17. Ambition is a poor excuse for not having enough sense to be lazy.
18. Hard work pays off in the future; laziness pays off now.
19. I intend to live forever ... so far, so good.
20. If Barbie is so popular, why do you have to buy her friends?
21. Eagles may soar, but weasels don't get sucked into jet engines.
22. What happens if you get scared half to death twice?
23. My mechanic told me, 'I couldn't repair your brakes, so I made your horn louder.'
24. Why do psychics have to ask you for your name?
25. If at first you don't succeed, destroy all evidence that you tried.
Links to e-mail to your new patients:
These are the links to send to prospective patients so that they can have their paperwork filled out before they come to see you, or if you have an office web site, you can post these links there:
New Patient intake form: http://www.eznotesinc.com/docs/patient_intake_form.pdf
Auto Accident form: http://www.eznotesinc.com/docs/Auto%20Accident%20Questionnaire.pdf
Workman’s Comp: http://www.eznotesinc.com/docs/Work%20Comp%20Intake%20Form.pdf
Below are the forms that have been re-worked to follow the software more closely, use which ever you want: http://www.eznotesinc.com/docs/major_med_case_or_cash.pdf
Remember: Back up your patient data (preferably onsite with a hard drive and off site as well), back up your customization (on a flash drive, as noted above) and keep your E-Z Notes Install disc or Flash drive safe, you’ll sleep better.
If you are ever unable to perform an update, your tech support may have expired. Call me to renew it at: 312.212.1602
If you would like to read previous issues of “New to Use”, go to our website: http://www.eznotesinc.com , or click the link below: http://eznotes.websitetoolbox.com/?forum=36645
Be like a postage stamp. Stick to it until you get there.
And be of service to others!
Dr. Michael Silbert
E-Z Notes Inc.
141 West Jackson Blvd. Suite A-20