January 19, 2007
Cranial-Sacral Therapy’s Wide Range of Applications |
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Lying within their scope of practice in the majority of regulated states, massage therapists can fortunately utilize cranial-sacral therapy to the benefit of their clients. See how adding this modality to a bodywork treatment plan can greatly enhance your ability to address a variety of client ailments.
by Nicole Cutler, L.Ac.
Based on the belief that the cranial bones are not fused, American osteopath William Garner Sutherland developed cranial-sacral therapy in the 1930s. Previous to Sutherland’s work, medical practitioners believed that the cranium’s sutures permanently mended the skull bones together, forming an immobile casing for the brain. Careful examination of the skull’s sutures reveals zipper-like lines designed to allow for the subtle movement of the cranial bones.
Sutherland proposed that skull bones move in unison with the rhythmic flow of cerebrospinal fluid surrounding the brain and spinal cord. Cerebrospinal fluid is responsible for nourishing and protecting the central nervous system. Just like energy, blood or lymph circulation, the flow of cerebrospinal fluid can become blocked. Cranial-sacral therapy is primarily comprised of subtle and gentle techniques to release any blockages inhibiting the free flow of cerebrospinal fluid. Adjusting the cranial bones restores mobility to this enclosed system and reduces stress on all of the involved tissues.
Each organ, muscle or tissue within the body is linked to a precise area of the cranial-sacral system through its nerve pathway and associated fascial connections. These nerve and fascial connections facilitate diagnosis and treatment for many dysfunctions. Once a restriction in the central nervous system is identified, cranial-sacral therapy can free it.
Cranial-sacral therapy can be learned easily and incorporated into any bodywork session. While this technique can benefit just about anyone, it is especially helpful for the following conditions:
1. Headaches can have a multitude of causes, but are generally accompanied by a circulatory restriction within the cranium. Freeing those restrictions can be a powerful technique to relieve frontal, vertex, temporal, parietal and occipital headaches.
2. Head injuries typically occur following some type of blow to the head. The force from the impact can misalign any number of cranial bones, disturbing the cerebrospinal fluid circulation and causing pain. The gentle manipulation of cranial-sacral therapy can relieve pain by realigning skull bones to open previously restricted fluid flow.
3. Ear infections typically arise from stagnation of fluids in the middle ear. Due to a lack of drainage through the eustachian tubes, fluid accumulates in the middle ear. Congestion of the eustachian tube may be a result of compression or distortion during the birth process or can be due to an accumulation of mucus. Cranial-sacral treatment can remove obstructions and ensure the drainage of fluids.
4. Birth trauma can cause many common childhood conditions such as colic and attention deficit disorder. During the forceful compression of the head twisting through the narrow birth canal, the cranium of a newborn is designed to adapt and flex for its dramatic entrance into the world. However, intense compression of this delicate structure over many hours can push the cranial bones up against each other, distorting the shape of the head. While normal and unavoidable, cranial bones that remain distorted may prevent the proper formation of the skull, affecting development of the brain or impinging on nearby nerves and blood vessels. Cranial-sacral therapy is safe on children and can realign the misaligned cranium.
5. Temporal Mandibular Disorder (TMJ) involves tension and misalignment of the mandible and temporal bones. Cranial-sacral therapy’s adjustments to the mastoid, temporal, zygomatic and sphenoid bones can provide TMJ relief.
6. Insomnia and Anxiety may not be associated with misalignment of the skull, but cranial-sacral therapy’s invigoration of cerebrospinal fluid can bring someone with anxiety or insomnia significant relief. Since cranial-sacral therapy is inherently relaxing, it has been used to ease anxiety and insomnia.
7. Autism has been shown by recent medical research in Canada to be associated with reduced blood supply to the temporal and frontal lobes of the brain. An association has also been made between autism and restricted mobility of the temporal and frontal bones, restricting blood flow to these areas of the brain. It is this association that makes the gentle application of cranial-sacral therapy ideal for treating autism.
8. Seizures occur when hyperexcitable nerve cells in the brain fire abnormally. Keeping the cerebrospinal fluid flowing without restriction to bathe the brain keeps nerve cells nourished. This nourishment has the benefit of reducing the susceptibility of seizures.
Widely applicable, cranial-sacral therapy can be an extremely valuable technique to include in a massage therapy session. As recognition of cranial-sacral therapy increases, so will the number of consumers requesting the modality in their sessions.
Recommended Study:
Cranial-Sacral Therapy
References:
Attlee, Thomas, Cranio-sacral therapy and the treatment of common childhood conditions, The Health Visitor, July 1994.
Upledger, John, DO, OMM, Easing Seizures, Massage Today, August 2006.
www.altguide.com , Cranio-sacral therapy, Oliver Nash, The Alternative Guide, 2006.
www.bbc.co.uk, Cranial Osteopathy, Jacqueline Young, BBC, 2005.
www.healing-arts.org, CranioSacral Therapy, The Healing Center On-line, 2006.
Posted by Editors at 08:41 AM
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January 18, 2007
Hypertension: Massage Indication or Contraindication? |
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Being a responsible massage therapist often means combining information from various sources to arrive at an educated conclusion. In the case of treating a client with hypertension, choosing the best way to proceed can be tricky. While modern research touts its ability to reduce blood pressure, massage therapy is also one of the most commonly taught contraindications for hypertension.
Nicole Cutler, L.Ac.
Hypertension, or high blood pressure, is a serious condition affecting one in four American adults. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats, it pumps blood into the arteries. Blood pressure is at its maximum at this time; this is known as the systolic blood pressure. When the heart is at rest between beats, blood pressure falls; this is known as the diastolic pressure. Hypertension is defined as an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both. Although there aren’t many noticeable signs of hypertension, it increases the risk of both heart disease and stroke.
The Contraindication
When a person has hypertension, excessive pressure is exerted against their blood vessel walls. An activity that might increase an already heightened intra-vascular pressure risks rupturing the blood vessel, a potentially dangerous scenario. One of the physiological effects of massage, especially a circulatory massage, is blood circulation augmentation.
Massage frees tissue congestion by moving stagnant blood out of a tightened area and flooding it with new, fresh blood. An increase in blood circulation can increase intra-vascular pressure. This is the reasoning behind a massage therapist’s caution with a hypertensive client.
The Irony
While many new therapists adhere to the contraindications as if they were absolute, there is considerable evidence to the contrary. Overwhelming evidence demonstrates that massage therapy can reduce blood pressure:
• As early as 1999, researchers from the Touch Research Institute, the University of Miami School of Medicine and Nova Southeastern University in Florida conducted the study "High blood pressure and associated symptoms were reduced by massage therapy". In this study, participants with controlled hypertension were randomly assigned to either a massage therapy group or a progressive relaxation group. Results showed that while both groups had lower anxiety levels and lower levels of depression, only the massage therapy group showed decreases in sitting diastolic and systolic blood pressure as well as cortisol stress-hormone levels.
• Published in 2005, researchers at the University of South Florida tested the effects of a regularly applied back massage on the blood pressure of patients with clinically diagnosed hypertension. Based on significant point reductions in both systolic and diastolic pressure readings, researchers concluded that regular massage lowers blood pressure in people with hypertension.
• As a result of the general understanding that massage lowers blood pressure, a 2006 National University of Health Sciences study sought to determine blood pressure changes following different types of therapeutic massage modalities. Researchers determined that Swedish massage had the greatest effect in reducing blood pressure readings, while potentially painful techniques, such as trigger point therapy, might have the opposite effect.
According to medical massage expert, Boris Prilutsky, massage’s mobilization of skin, connective tissue, muscle tissue and the periosteum, stimulates receptors that send messages of relaxation to the central nervous system. These reflexes cause vasodilation, resulting in decreased blood pressure and heart rate.
Practicing Sensibly
What is a practitioner to do when a client presents with high blood pressure? Conventional texts claim this condition to be a contraindication to massage, while research consistently demonstrates massage can be helpful to someone with elevated blood pressure. With conflicting information about working with hypertensive clients, massage therapists must take this investigation one step further before making their decision. The following suggestions will help devise an action plan:
• If a client’s high blood pressure is not controlled, get permission from their healthcare practitioner prior to massage. Determining if their blood pressure is controlled will require extra effort during the intake process. Some clients may be alarmed at a request to consult with their doctor, but explaining your concerns will foster their trust in you. When in doubt, always seek the permission from the physician treating a client with high blood pressure.
• When working with hypertension, choose massage modalities to encourage the relaxation response in lieu of intense and possibly painful techniques. Examples of modalities particularly suited for relaxation and hypertension include Swedish massage, cranial-sacral therapy and reflexology.
Whenever conflicting information places you in a professional quandary, further evaluation is required. This is certainly the case in administering massage to a client with high blood pressure. Although massage therapy will likely increase the circulation within the blood vessels, relaxing strokes will concurrently dilate those vessels. The net result of massage’s simultaneous circulation enhancement and vessel dilation is a reduction in body tension and blood pressure. The danger of enhanced circulation is typically only dangerous when a person’s blood pressure is not controlled, requiring the client’s physician to give a massage therapist the green light to commence with bodywork.
Recommended Study:
Swedish Massage
Cranial –Sacral Therapy
Reflexology
References:
Cambron JA, Dexheimer J, et al., Changes in Blood Pressure After Various Forms of Therapeutic Massage, Journal of Alternative and Complementary Medicine, January/February, 2006.
Gottlieb, Bill, New Choices in Natural Healthcare, Rodale Press, Inc., 1995.
Olney CM, The Effect of Therapeutic Back Massage in Hypertensive Persons, Biological Research for Nursing, October 2005.
Prilutsky, Boris, Medical Massage and Control of Arterial Hypertension, Massage and Bodywork, August/September 2003.
www.massagemag.com, High Blood Pressure Reduced by Massage Therapy, Massage Magazine, Inc., 2001.
www.umm.edu, Hypertension, A.D.A.M., Inc., 2006.
Posted by Editors at 02:16 PM
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January 17, 2007
Massage for Eye Health |
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Stronger prescriptions and surgery are not the only options for improving eyesight. Learn how massage therapists with knowledge of Traditional Chinese Medicine can aid clients in their efforts to improve and support the health of their eyes.
Nicole Cutler, L.Ac.
While a significant percentage of our society experiences declining vision, there appears to be a limited understanding of what can be done about it. In addition to corrective lenses or surgical procedures, massage therapists with an understanding of Traditional Chinese Medicine (TCM) can make a substantial contribution to the maintenance of sight. Principles of TCM can guide bodyworkers in choosing acupressure locations to therapeutically support client eye health.
General TCM Theory for the Eyes
Although massage therapists are not intended to be TCM diagnosticians, the following principles will be of value to enhancing assessment and acupressure skills.
According to TCM, diseases involving the eye are closely related to a liver imbalance. Whenever studying TCM theory, it is important to recall that a reference to an organ may include the actual organ, but also takes into account the accompanying meridian and its energy. So while an eye disorder may correspond to a liver imbalance, the liver itself may actually be healthy.
In addition to the liver’s primary role in vision, the eye is nourished by all of the internal organs in the body. Specifically, the health of different parts of the eye reflects the health of the following organ systems:
• The pupil and lens of the eye reflect kidney health
• The sclera reflects lung health
• The arteries and veins, as well as the inner and outer canthus, reflect heart health
• The flesh around the eye reflects spleen health
• The cornea and iris reflect liver health
Because an imbalance in any of the internal organs can be witnessed in different parts of the eye, taking note of a person’s eyes can help in choosing a protocol. Abnormal eye coloration suggests a pathological cause. For example, a client with a discoloration of the sclera would benefit from bodywork on the lung (reflective of the sclera) and liver (applicable for all eye imbalances) meridians. If the sclera discoloring is due to an abundance of inflamed blood vessels, the therapist might want to also work with the heart meridian.
Abnormal eye color is also representative of a system out of balance. Before making this connection, a therapist must understand the colors associated with each major organ system:
• Heart is associated with the color red
• Kidney is associated with the colors blue or black
• Spleen is associated with the colors orange or yellow
• Liver is associated with the color green
• Lung is associated with the color white
These color indicators help a therapist decide what meridian system is most important to address. For example, a client with bags beneath the eyes would likely benefit from bodywork to balance the spleen (reflected in the flesh around the eyes). If those bags were blue or black, the spleen bodywork could be supported with kidney meridian acupressure.
Specific Eye Acupressure Points
Applying acupressure to points around the eyes can be a powerful adjunct to a massage session. Some of the major therapeutic points are:
Urinary Bladder 1 - Located where the inner corner of the eye meets the nose. This point is advised for all types of eye problems, especially early-stage cataracts, glaucoma, conjunctivitis and blurry vision.
Urinary Bladder 2 - Located in the depressions at the inner (close to midline) ends of the eyebrows. Similar to Urinary Bladder 1, this point is advised for all types of eye problems, especially early-stage cataracts, glaucoma, conjunctivitis and blurry vision.
Yuyao (extra point) – Located at the midpoint of the eyebrow in the hollow. This point is good for eye problems related to worry, excessive studying and mental strain.
Triple Warmer 23 - Located in the depression at the outside end of the eyebrow. This local point benefits many eye and facial problems, including eye tics, burning eyes, watery eyes and blurry vision.
Gallbladder 1 - Located in the cavities on the outside corners of the eye sockets. This point is good for conjunctivitis, red and sore eyes, photophobia, dry, itchy eyes, early-stage cataracts, blurred vision and temporal headaches (especially when related to vision problems).
Stomach 1 - Located directly below the pupil on the infraorbital ridge bone. This point is indicated for sinus congestion, itchy, burning, dry eyes (especially when related to colds or allergies).
Acupressure on points near the eyes must be done gently, slowly and with clean hands. Do not massage on an open wound, a scar, burn or infection.
Using TCM theory will help massage therapists better understand a client’s eye complaints, improve assessment skills and result in a more directed, therapeutic treatment. In addition to regular visits to eye doctors, clients can also turn to massage to help improve and support the health of their eyes.
Recommended Study:
Shiatsu Anma
References:
www.acufinder.com, Acupressure Points for Better Vision, Dr. Marc Grossman, OD, LAc, 2006.
www.acupuncturetoday.com, Natural Vision Improvement: An Alternative to Lasik Surgery, Deborah E. Banker, MD, December 2001.
Posted by Editors at 01:47 PM
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January 05, 2007
9 Tips for Chapped Lips |
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With the blustery, cold air of winter come chapped, peeling, sore lips. Whether you are trying to heal your own chapped lips, or your clients are asking for suggestion on healing theirs, learn more about the most popular remedies for common wintertime lip woes.
Nicole Cutler, L.Ac.
The result of being too dry, everyone experiences chapped lips at one time or another. Unfortunately, some people have a severe and chronic problem due to the lips’ skin losing its moisture retention capacity. As a consequence, the lips become chapped, further reducing their moisture retention capacity and continuing the cycle of chronic and increasingly severe chapped lips. Dry, cracked or sore lips can interfere with many daily activities, such as smiling, kissing, eating and talking.
Lips may become chapped for a variety of reasons, including:
• Exposure to wind, sun, and cold, dry air. Since a person's lips are one of the most exposed parts of the body, they are typically affected by the elements before other parts of the body.
• Mouth breathing due to obstruction, as in allergic rhinitis, which dehydrates the lips.
• Contact dermatitis due to irritants or allergens in cosmetics or skin-care products.
• Certain medications, such as those used to treat acne.
• A habit of frequently licking your lips. When lips become chapped it is very common for people to lick their lips in an attempt to moisten them. Although saliva soothes momentarily, the act perpetuates the cycle of dry and irritated lips.
• Dehydration saps the body’s cells of moisture, including the lips.
• Vitamin deficiency is a surprising culprit in perpetually chapped lips. Certain nutritional deficiencies cause insufficient cellular hydration.
Whether you are trying to heal your own chapped lips, or have clients asking for suggestions on healing theirs, our experts have assembled a list of the most popular remedies for common wintertime lip woes:
1. Lip cream or balm - Apply lip balm frequently, especially before going out in cold, dry weather. Avoid flavored lip balms that can tempt you into lip licking.
2. Sunscreen - Because sun exposure can dry and burn the skin, use a lip cream or balm containing sunscreen to protect the lips from harmful rays.
3. Lip licking - Avoid licking your lips. Saliva evaporates quickly and digests the thin membrane protecting lips, leaving lips drier than before you licked them.
4. Hydrate - Stay hydrated by drinking plenty of water. Dehydration typically results in chapped lips.
5. Humidify - Use a humidifier or place a pot of water on a radiator to add moisture to the surrounding air.
6. Don’t smoke - Smoking will constantly evaporate any natural oils on the lips.
For severe cases where the preceding six tips are not helpful consider:
7. Consultation - If chapping is severe and self-care measures don't seem to help, consult a doctor. Occasionally, persistent chapped lips may indicate an underlying problem, such as a vitamin deficiency, fungal infection or allergic reaction.
Check with your physician before experimenting with tips eight and nine.
8. Hydrocortisone - Applying a small amount of an over-the-counter strength hydrocortisone cream may decrease lip inflammation enough so that lip cream or balm can be effective.
9. Rosen’s ointment - A pharmacist can prepare a severe chapped lip treatment called 1-2-3 ointment or Rosen’s ointment. It consists of 10 cc of Burrow's solution (aluminum acetate) mixed with 20 grams of Aquaphor and enough plain zinc oxide paste (about 30 cc) to make a two-ounce container. While this mixture is extremely protective and healing, it is typically undesired due to its white color.
More about Lip Balm
Lip balm or cream is the number one choice to maintain lip moisture and protect lips from a number of dehydrating factors. With all of the lip products on the market, choosing one can be dizzying. For effective lip relief without side effects, our experts suggest opting for all-natural ingredients with healing essential oils. In addition to purchasing lip balms or creams with these ingredients, you can also make your own.
All-natural emollients to enhance the lip’s moisture-retention capabilities include:
• Beeswax
• Shea or Cocoa Butter
• Olive, Avocado and Almond oil
• Vitamin E
• Lecithin
Essential oils often used for their skin healing properties include:
• Tea tree
• Grapefruit
• Lavender
• Rose
• Chamomile
• Lemon
• Lime
• Peppermint
While there is some support for the use of petroleum-based lip products, many healthcare enthusiasts find that this ingredient exhibits a negative rebound effect. Initially, a petroleum-based lip balm hydrates the lip’s cells, but repeated use will make the user dependant upon it for moisture. Petroleum prohibits the skin from breathing, perpetuating cell dehydration and in turn, increased lip chapping between product applications.
Whether you choose to make your own lip balm or need guidance for healing a painful set of lips, learning these basics of lip health can keep your and your client’s lips perfectly moist throughout the winter season.
Recommended Study:
Aromatherapy Essentials
References:
www.drgreene.com, Chapped Lip, Greene Ink Inc., 2006.
www.eaudrey.com, Cosmetics Recipe, Aromantic, 2004.
www.essentialoils.co.az, Chapped Lips, Esoteric Oils CC and Sallamander Concepts (Pty) Ltd., 2006.
www.goaskalice.columbia.edu, Chapped Lips Just Won’t Quit, The Trustees of Columbia University in the City of New York, 2006.
www.karitegold.com, Severe, Chronic, Dry Chapped Lips, KariteGold, 2003.
www.mayoclinic.com, Chapped Lips: What is the Best Remedy?, Mayo Foundation for Medical Education and Research, 2006.
Posted by Editors at 03:52 PM
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January 04, 2007
How Massage Can Help Your Clients Lose Weight |
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Countless resolutions to lose weight accompany each New Year. See how your massage services can help clients start 2007 feeling healthy and looking good.
Nicole Cutler, L.Ac.
Physicians, dieticians, personal trainers and body sculpting professionals all agree that any healthy, risk-free, effective plan to lose weight involves both diet and exercise. While controlled diet and regular exercise directs the body’s proportions, exercise is primarily responsible for carving off previously gained weight. Just as bacon fat will only liquefy at warmer temperatures, body fat can only come off the body with physical activity. By enabling your client’s weight-loss program, massage is a perfect ally to a disciplined diet and exercise routine. Massage therapy supports exercise and weight loss in many ways, including:
1. Improves ability for physical activity
2. Reduces risk of injury
3. Increases metabolic rate
4. Reduces abdominal fat hormone
5. Physical bursting of fat capsule
6. Supports digestive functions
7. Rewards dedication and hard work
Improves Ability for Physical Activity
New research finds that massage therapy can actually enhance the effects of exercise. Orthopedist Dr. Jason Ford says, "I recommend massage therapy for my patients who only exercise a couple of times a week to help improve flexibility and blood flow but to also help them with the soreness and stiffness they experience after their exercise." Since massage increases oxygenation of muscle tissue, it helps sustain endurance and shorten recovery time. This allows muscles to maintain maximum power and performance when active, and burn the maximum number of calories in the process.
Reduces Risk of Injury
A well-known fact to professional athletes, massage also supports regular physical activity by preventing injuries. By stretching connective tissue, massage improves circulation and helps to prevent the break down of adhesions and scar tissue resulting from muscle tears and other common muscle injuries. Massage also influences the excretion of certain fluids (nitrogen, phosphorous, sulfur) that aid in tissue repair. A prime suspect in unsuccessful weight-loss attempts is suffering from an injury that severely limits physical activity.
Increases Metabolic Rate
Metabolism is enhanced through the increased interchange of nutritive substances between blood and tissue cells that comes with healthy circulation. Maximizing the supply of nutrients and oxygen through increased blood flow allows muscles to burn more calories.
Reduces Abdominal Fat Hormone
Released in response to physical and emotional stress, the hormone cortisol has been shown to increase appetite and cause fat deposition in the abdominal area. While exercise is the best method for lowering cortisol levels, massage has been repeatedly proven to reduce circulating levels of this hormone. Massage’s ability to lower cortisol levels helps ease stress, decrease appetite and reduce accumulation of belly fat; all of which support a weight-loss program.
Physical Bursting of Fat Capsule
Massage may directly aid in fat loss. According to some research studies, vigorous massage can burst the fat capsules in subcutaneous tissue. This bursting causes adipose tissue to exude, setting the stage for its removal. Lymphatic drainage techniques are ideal near areas of deep tissue work to help the body accommodate, process and eliminate the toxins or fat just released. Only to be considered in combination with proper nutrition and exercise, bursting fat capsules may directly help in weight loss.
Supports Digestive Functions
A smoothly functioning digestive system is critical to achieving one’s target weight. Since supplying the body with the fuel it needs for energy, allocating fat for burning or storing and eliminating waste products all fall under the gastrointestinal system’s domain, making its health instrumental in body proportion and size. Massage therapists can promote digestive health through administering techniques such as belly massage and meridian (stomach, spleen and large intestine) bodywork.
Rewards Dedication and Hard Work
In addition to all of the physiological reasons massage therapy supports weight loss, bodywork also serves as an emotional motivator. Celebrating life’s accomplishments without sabotaging a slimmer waistline encourages sticking to a weight-loss program. Receiving regular massage is the ultimate and appropriate reward for dedication to body improvement. For a person struggling with their weight, looking forward to a scheduled massage serves as inspiration to eat properly and complete a challenging workout.
While massage therapy does not replace the standards of diet and exercise for losing weight, its addition to a weight-loss program can help to shed pounds.
Recommended Study:
Swedish Massage
Neuromuscular Therapy
Sports Massage
Lymphatic Drainage
References:
www.ezinearticles.com, Weight Loss Benefits of Massage, Scott Haywood, EzineArticles.com, 2006.
www.medicinenet.com, Stress, Hormones and Weight Gain, Melissa Conrad Stoppler, MD, MedicineNet Inc., September 2006.
www.wistv.com, Study Finds Massage with Exercise Can Aid Weight Loss, WorldNow, March 18, 2004.
Posted by Editors at 04:08 PM
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January 02, 2007
Insurance Billing for the Massage Therapist |
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As scientific research continues to prove the value of massage therapy, an increasing number of insurance companies now cover massage therapy as an acceptable and billable therapeutic service. Here's how to deal with insurance companies so you can expand your client base and increase the profitability of your practice.
Nicole Cutler, L.Ac.
While running a cash-based business can be a successful venture, there are many reasons to consider accepting and billing insurance companies. Although you can have a successful massage business without billing insurance companies, knowing how to bill will come in handy when one of your clients asks you to bill the insurance company for them. You also can build a practice totally dependent on insurance cases and work with integrity when you know all the rules, regulations and issues.
Where Billing is Okay
All 50 states allow massage therapists to bill insurance companies for massage sessions with clients who are either injured on the job (workers compensation) or in a motor vehicle accident.
A handful of states permit massage therapists to be contracted providers within the healthcare system. With new legislation constantly emerging, be sure to check on the most current insurance billing guidelines in your state. Additionally, experts in the field suggest using an insurance verification form prior to bill submission. This form confirms that your client is covered by an insurance company who will accept your charges.
Six Insurance Billing Hints
Interacting with insurance companies correctly will pay off. The following hints will help any massage therapist realize that billing insurance isn’t very hard:
1. Documentation assures payment – make certain your SOAP notes accurately reflect what occurred, chart progress and cover what you billed for.
2. Always follow the doctor’s prescription.
3. Only bill insurance companies that will reimburse a massage therapist.
4. Stay within your scope of practice.
5. Use the correct form and be sure to fill it out correctly.
6. Use the proper, most current codes.
7. When applicable, bill in 15 minute increments.
8. Confirm a procedure code is accepted by a company prior to submission.
Procedure Code Tips
The American Medical Association produces a manual each year containing thousands of codes for known medical procedures. Due to the ever-changing field of medicine, this manual is revised yearly. While primarily intended for physicians, other medical modalities use the codes to describe and bill for the work they do. Combined with the World Health Association’s International Classification of Disease (ICD) codes, the Current Procedural Terminology (CPT) codes offer a concise and accurate description of the medical professional’s actions. Massage therapists use just a few codes from the Physical Medicine and Rehabilitation section of the CPT manual. Since massage therapists do not diagnose conditions, the ICD code must be acquired from a prescribing medical specialist.
Even though there are a plethora of massage techniques used by today’s bodyworkers, there are not enough codes to represent them. Whenever change enters a well-established institution, as massage therapy has entered mainstream medicine, it takes years for all of the components to reflect the change. Until the CPT codes catch up with techniques commonly practiced by massage therapists, codes must be used that fall within a massage therapist’s scope of practice and that accurately describe the therapy.
The two most commonly accepted codes for massage therapy are:
1. 97124 Massage – This code is used for Swedish Massage
2. 97140 Manual Therapy Techniques – This code encompasses manual traction and manual lymphatic drainage therapy
As the code guidelines can change, double check which code is appropriate for myofascial release. In our research we discovered conflicting information regarding the code for myofascial release. The easiest and most reliable way to check this is directly with the insurance company to be billed.
Additionally, do not use codes 97124 and 97140 to bill for massage work during the same session. The Correct Coding Initiative of Medicare has determined that there is not enough difference between these two codes to allow claim of their use in the same therapy session.
As massage therapists are becoming increasingly recognized as healthcare providers, insurance billing will emerge from being optional to being a necessity. Making the extra effort to learn about insurance billing’s ins and outs will take the fear and difficulty away. The practitioners who shy away from this method of expanding a massage business are typically those who weren’t instructed to do it correctly. Don’t sell yourself short by limiting your practice; take the steps to learn how to correctly bill insurance companies.
Recommended Study:
Ethical Case Management
References:
Denning, Ed, Massage Therapy Medical Codes for 2004, Massage and Bodywork, February-March 2004.
Madison-Mahoney, Vivan, Coding for Insurance Billing and Medicare Issues, Massage Today, February 2006.
www.thebodyworker.com, Introduction to The Massage Insurance Billing Manual,
Julie Onofrio, LMP, June 2004.
Posted by Editors at 02:52 PM
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