CHIROPRACTIC AND ACUPUNCTURE APPROACHES
TO CARPAL TUNNEL SYNDROME

Manipulative procedures may have a role in treating CTS by decreasing symptoms and improving function. A type of stretching treatment called myofascial release improved the symptoms of a patient with CTS in one published case report, (20) and similar treatments combined with specific wrist manipulations and self stretches were further tested in a small, preliminary trial. (21) Participants in this study experienced a decrease in pain, numbness, and weakness, and their nerve function improved as well.

A small, preliminary trial assessed a chiropractic treatment program consisting of exercises, soft tissue therapy, and manipulation of the wrist, the upper extremity, the spine, and the ribs. (22) The treatment resulted in improvement in grip and thumb strength, muscle function, flexibility, and overall function, as well as a decrease in pain among people with CTS. In a follow-up study, six months later, most of the improvement had been maintained. (23) A controlled clinical trial compared traditional
medical and chiropractic care for CTS. (24) People with CTS received either standard medical care (Ibuprofen and nighttime wrist supports) or chiropractic care (manipulation of the wrist, elbow, shoulder, neck, and spine, as well as massage to the soft tissues). Ultrasound and nighttime splints were also used in the chiropractic treatments. People in both groups improved significantly and similarly in terms of pain reduction, increased function, and improved finger sensation and nerve function,
but the chiropractic group reported fewer side effects.

Acupuncture may be useful in the treatment of CTS. In a preliminary trial, people with CTS (some of whom had previously undergone surgery) received either acupuncture or electro-acupuncture (acupuncture with electrical stimulation). Eighty-three percent of the participants in this trial experienced complete relief that lasted through two to eight years of follow-up. (18) After reviewing all available scientific literature on the topic, a consensus conference convened in 1997 by the National Institutes
of Health concluded that acupuncture for CTS “may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.” (19)

Complete superscript references can be E mailed upon request from sam@hjrossnetwork.com


CONSUMER REPORTS: CHIROPRACTORS PREFERRED

A Consumer Reports survey, August 2005 edition, of more than 34,000 readers, reported many people have used chiropractic care, and many more medical doctors are now recommending it. Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments,
including prescription drugs, by readers with back pain. (Readers said it also provided relief for neck pain, but neck manipulation can be risky and is not recommended by CR.) Deep-tissue massage was found to be especially effective in treating osteoarthritis and fibromyalgia. While readers suffering from back pain deemed acupuncture and acupressure less effective than chiropractic and massage, one-fourth of readers who had tried these therapies said they helped them feel much better. Of all the hands-on alternative therapies, Consumer Reports noted that acupuncture has the most scientific support.

 

Medicare Claims for HPSA bonus payments will no longer use modifiers QB and QU. For all dates of service after 1-1-2006 modifier AQ must be used to identify HPSA service areas (MM 3935)

ABN
Do I need an ABN for every visit if Medicare may not cover it? It is not necessary to fill out a separate Advanced Beneficiary Notice (ABN) each time a patient returns for the same treatment (such as weekly foot care, chiropractic manipulations). Each service or series of treatment must be documented with the individual date(s), and the patient’s signature on the form, along with the narrative description of the procedure. If each service is not listed individually on the ABN or the service is not part of a series, then a separate form is required. Services Medicare excludes as covered
benefits do not require an ABN; however, providers may choose to use the Notice of Exclusions from Medicare Benefits form. The optional notice allows the beneficiary to remain informed on a service that Medicare never covers.

Diagnosis ICD9 CM
There are 26 pages of changes for 2006 (effective date 10-1-2005), but there are no changes related to common musculoskeletal or related diagnoses. Therefore if you have a current edition and do not wish to purchase a 2006 we can e mail the changes. Request from sam@hjrossnetwork.com

NPI National Provider Identifier will replace health care provider identifiers in use today for standard health care transactions. This identifier will be a unique 10 digit number required on electronic transactions. Providers can apply for their numbers now, with an effective date of compliance being May 23, 2007. All providers may apply for their NPI through CMS (https://nppes.cms.hhs.gov). Though intended for electronic transactions, expect it to be used for paper claims. This is simply another phase of HIPAA.

CPT and HCPCS 2006 We have been unable to secure any official notice on changes but the early word is that there are no changes pertinent to chiropractic, acupuncture, or physical medicine coding.