RE: How are you charging for Dry Needling?

[Guest guest]

I have used dry needling for the past 16 years in my practice and teach the

technique all over the world. I believe that dry needling is a manual therapy

technique, which is supported by the position statement of the American Academy

of Orthopaedic Manual Therapists accepting dry needling as a technique within

the scope of manual physical therapy. Therefore, I believe that the best code

for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions have

included neuromuscular education, therapeutic activity, and others. Fact is

that dry needling should not be a technique by itself but should always be part

of a more comprehensive treatment approach. In other words, I am not sure that

dry needling should be considered as a separate billable item, but more as a

technique within manual physical therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@...

http://www.linkedin.com/in/jandommerholt

[Guest guest]

Dr. Dommerholt -

Thank you for your clear and concise response.

SRK

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of Dr. Jan Dommerholt

Sent: Thursday, June 23, 2011 1:03 PM

To: PTManager

Subject: Re: How are you charging for " Dry Needling " ?

I have used dry needling for the past 16 years in my practice and teach

the technique all over the world. I believe that dry needling is a

manual therapy technique, which is supported by the position statement

of the American Academy of Orthopaedic Manual Therapists accepting dry

needling as a technique within the scope of manual physical therapy.

Therefore, I believe that the best code for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions

have included neuromuscular education, therapeutic activity, and others.

Fact is that dry needling should not be a technique by itself but should

always be part of a more comprehensive treatment approach. In other

words, I am not sure that dry needling should be considered as a

separate billable item, but more as a technique within manual physical

therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

<mailto:dommerholt%40bethesdaphysiocare.com>

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@... <mailto:dommerholt%40myopainseminars.com>

http://www.linkedin.com/in/jandommerholt

[Guest guest]

Dr. Dommerholt -

Thank you for your clear and concise response.

SRK

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of Dr. Jan Dommerholt

Sent: Thursday, June 23, 2011 1:03 PM

To: PTManager

Subject: Re: How are you charging for " Dry Needling " ?

I have used dry needling for the past 16 years in my practice and teach

the technique all over the world. I believe that dry needling is a

manual therapy technique, which is supported by the position statement

of the American Academy of Orthopaedic Manual Therapists accepting dry

needling as a technique within the scope of manual physical therapy.

Therefore, I believe that the best code for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions

have included neuromuscular education, therapeutic activity, and others.

Fact is that dry needling should not be a technique by itself but should

always be part of a more comprehensive treatment approach. In other

words, I am not sure that dry needling should be considered as a

separate billable item, but more as a technique within manual physical

therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

<mailto:dommerholt%40bethesdaphysiocare.com>

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@... <mailto:dommerholt%40myopainseminars.com>

http://www.linkedin.com/in/jandommerholt

[Guest guest]

Anyone who bills an insuror must use CPT Codes. The AMA's CPT Code book

specifies in its beginning pages that the clinician must use the code which

*exactly* describes the technique they perform, not one which comes closest.

If a clinician is using a technique which is not *exactly* what is

stipulated in the CPT Code description, the instructions tell them to use a

code for Unlisted Procedure.

So, it is not like the SATs, where one selects an answer which " most nearly "

matches.

Unfortunately, we now live in an age where making an error can be construed

as fraud. We must be careful.

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Mobile

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Dr. Jan Dommerholt

Sent: Thursday, June 23, 2011 3:03 PM

To: PTManager

Subject: Re: How are you charging for " Dry Needling " ?

I have used dry needling for the past 16 years in my practice and teach the

technique all over the world. I believe that dry needling is a manual

therapy technique, which is supported by the position statement of the

American Academy of Orthopaedic Manual Therapists accepting dry needling as

a technique within the scope of manual physical therapy. Therefore, I

believe that the best code for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions have

included neuromuscular education, therapeutic activity, and others. Fact is

that dry needling should not be a technique by itself but should always be

part of a more comprehensive treatment approach. In other words, I am not

sure that dry needling should be considered as a separate billable item, but

more as a technique within manual physical therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda PhysiocareR, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

<mailto:dommerholt%40bethesdaphysiocare.com>

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@... <mailto:dommerholt%40myopainseminars.com>

http://www.linkedin.com/in/jandommerholt

[Guest guest]

Well said Dick. To me, dry needling is billed under 97799 until the American

Medical Association (AMA) comes out in a CPT Assistant publication and tells me,

you, and others otherwise. Several payor policies address dry needling and state

it is non-covered. Just because you billed dry needling under 97140 and were

paid for it does not mean you were supposed to be paid for it. If that payor

reviewed your documentation and saw you were doing dry needling, would you keep

the money?

A perfect example is ice massage. Many providers were billing that under 97124

since they said they were doing massage. The AMA came out in August 2007 CPT

Assistant, I believe, and said ice massage is a component of 97010 (hot or cold

packs).

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

View upcoming audio conferences at http://www.gawendaseminars.com/news.aspx

Subject: RE: How are you charging for " Dry Needling " ?

To: PTManager

Date: Saturday, June 25, 2011, 9:15 AM

 

Anyone who bills an insuror must use CPT Codes. The AMA's CPT Code book

specifies in its beginning pages that the clinician must use the code which

*exactly* describes the technique they perform, not one which comes closest.

If a clinician is using a technique which is not *exactly* what is

stipulated in the CPT Code description, the instructions tell them to use a

code for Unlisted Procedure.

So, it is not like the SATs, where one selects an answer which " most nearly "

matches.

Unfortunately, we now live in an age where making an error can be construed

as fraud. We must be careful.

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Mobile

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Dr. Jan Dommerholt

Sent: Thursday, June 23, 2011 3:03 PM

To: PTManager

Subject: Re: How are you charging for " Dry Needling " ?

I have used dry needling for the past 16 years in my practice and teach the

technique all over the world. I believe that dry needling is a manual

therapy technique, which is supported by the position statement of the

American Academy of Orthopaedic Manual Therapists accepting dry needling as

a technique within the scope of manual physical therapy. Therefore, I

believe that the best code for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions have

included neuromuscular education, therapeutic activity, and others. Fact is

that dry needling should not be a technique by itself but should always be

part of a more comprehensive treatment approach. In other words, I am not

sure that dry needling should be considered as a separate billable item, but

more as a technique within manual physical therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda PhysiocareR, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

<mailto:dommerholt%40bethesdaphysiocare.com>

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@... <mailto:dommerholt%40myopainseminars.com>

http://www.linkedin.com/in/jandommerholt

[Guest guest]

I object to the notion that dry needling should be billed under the 97799 code.

I understand the notion that the fact that one is getting paid does not mean

that services were billed with the appropriate code. As I stated before, I do

not believe that dry needling should be considered a stand-alone procedure, and

in that sense, I should have been more clear and not suggest that dry needling

by itself should be billed under the 97140 code. Dry needling should always be

part of other manual procedures and as such is folded into the manual therapy

code. After reading my previous reply, I should have stated that dry needling is

not a billable procedure as there is no specific code for dry needling. I am

not an expert in coding, but this makes perfect sense to me. I am not convinced

that payors have any understanding of what they are denying when they do not

cover dry needling. Discussions with many physical therapists with strong

opinions about dry needling usually reveals that they have never attended any

courses in dry needling and therefore render opinions without any idea what they

are talking about. Having said this, I do understand that not all providers of

dry needling courses agree that dry needling should be considered a component of

manual therapy. I would not bill the Graston technique under the 97799 code.

Proponents of the Graston technique consider it an instrument-assisted manual

therapy. Dry needling is also an instrument-assisted manual therapy.

There is much evidence that dry needling can shorten the duration of physical

therapy. Dry needling leads to an immediate reduction of pain, reduces the

sensitivity of trigger points, and even of remote trigger points, and reduces

endplate noise which is an indication that dry needling reduces central

sensitization. Dry needling immediately reduces levels of CGRP and substance P

according to studies of the National Institutes of Health. Dry needling

normalizes motor activation patterns and improves range of motion. Trigger

points are persistent sources of nociceptive input, which are removed with dry

needling. Insurance companies seem short-sighted when they deny the one manual

therapy treatment component for which there is ample scientific support. I have

been challenged by insurance companies and every time have been able to reverse

their initial denial by providing scientific support for my manual physical

therapy approach which includes dry needling. A few references for those who

may be interested:

Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA.

Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur

J Pain. 2011 Jan;15(1):61-9.

Fernandez-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera

J, Ge HY, et al. Short-term effects of dry needling of active myofascial trigger

points in the masseter muscle in patients with temporomandibular disorders. J

Orofac Pain. 2010;24(1):106-12.

Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key

myofascial trigger point may reduce the irritability of satellite MTrPs. Am J

Phys Med Rehabil. 2007 May;86(5):397-403.

Lucas KR, Polus BI, Rich PS. Latent myofascial trigger points: their effects on

muscle activation and movement efficiency. J Bodyw Mov Ther. 2004;8:160-6

Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular

positioning muscles during loaded scapular plane elevation: the effects of

latent myofascial trigger points. Clin Biomechanics. 2010;25(8):765-70

Shah J, T, Danoff JV, Gerber LH. A novel microanalytical technique for

assaying soft tissue demonstrates significant quantitative biomechanical

differences in 3 clinically distinct groups: normal, latent and active. Arch

Phys Med Rehabil. 2003;84:A4.

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, TM, et al.

Biochemicals associated with pain and inflammation are elevated in sites near to

and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008

Jan;89(1):16-23.

Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle motor points

for chronic low-back pain: a randomized clinical trial with long-term follow-up.

Spine. 1980;5(3):279-91.

Ga H, Koh HJ, Choi JH, Kim CH. Intramuscular and nerve root stimulation vs

lidocaine injection to trigger points in myofascial pain syndrome. J Rehabil

Med. 2007;39(5):374-8.

Tsai C-T, Hsieh L-F, Kuan T-S, Kao M-J, Chou L-W, Hong C-Z. Remote effects of

dry needling on the irritability of the myofascial trigger point in the upper

trapezius muscle. Am J Phys Med Rehabil. 2010;89(2):133-40.

Kuan TS, Hsieh YL, Chen SM, Chen JT, Yen WC, Hong CZ. The myofascial trigger

point region: correlation between the degree of irritability and the prevalence

of endplate noise. Am J Phys Med Rehabil. 2007;86(3):183-9.

Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. Inhibitory effect of dry

needling on the spontaneous electrical activity recorded from myofascial trigger

spots of rabbit skeletal muscle. Am J Phys Med Rehabil. 2001 Oct;80(10):729-35.

Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of

lidocaine injection, botulinum toxin injection, and dry needling to trigger

points in myofascial pain syndrome. Rheumatol Int. 2005 Oct;25(8):604-11.

Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. Trigger point acupuncture for

treatment of knee osteoarthritis--a preliminary RCT for a pragmatic trial.

Acupunct Med. 2008 Mar;26(1):17-26.

Fernández de las Peñas C, Cuadrado M, Arendt-Nielsen L, Simons D, Pareja J.

Myofascial trigger points and sensitization: an updated pain model for

tension-type headache. Cephalalgia. 2007;27(5):383-93.

Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central modulation of pain evoked

from myofascial trigger point. Clin J Pain. 2007 Jun;23(5):440-8.

Pérez-Palomares S, Oliván-Blázquez B, Magallón-Botaya R, De-la-Torre-Beldarraín

M, Gaspar-Calvo E, Romo-Calvo L, et al. Percutaneous Electrical Nerve

Stimulation Versus Dry Needling: Effectiveness in the Treatment of Chronic Low

Back Pain. J Musculoskeletal Pain. 2010;18(1):23-30.

Hong CZ, Lidocaine injection versus dry needling to myofascial trigger point.

The importance of the local twitch response. Am J Phys Med Rehabil 73(4):

256-63, 1994.

There are many others..........!

I am looking forward to the day that the APTA will follow the lead of the AAOMPT

and recognize dry needling as a technique within the scope of PT practice and

recommend to the AMA that dry needling is indeed a component of manual therapy.

Dry needling is not a modality that requires a CPT code. Dry needling is just a

treatment technique.

Jan Dommerholt

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

www.bethesdaphysiocare.com

Anne Arundel Physiocare®

127 Lubrano Dr, Suite L-3

polis, MD 21401-7322

+ (voice)

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@...

http://www.linkedin.com/in/jandommerholt

[Guest guest]

Rick,

I would disagree with you that dry needling, an instrument assisted manual

therapy technique, should be coded as something that it is not.  I have met

numerous physical therapists, osteopaths, and chiropractors who utilize this

technique, and not a single one of them has stated that they code this as

97799.  Every one of them including those physical therapists who teach dry

needling advocate on coding this manual therapy technique as a manual therapy

procedure (i.e. CPT 97140). 

Sumesh , PT, , DPT, OCS

Fellow of the American Academy of Orthopaedic Manual Physical Therapy

________________________________

To: PTManager

Sent: Mon, June 27, 2011 5:20:05 PM

Subject: RE: How are you charging for " Dry Needling " ?

 

Well said Dick. To me, dry needling is billed under 97799 until the American

Medical Association (AMA) comes out in a CPT Assistant publication and tells me,

you, and others otherwise. Several payor policies address dry needling and state

it is non-covered. Just because you billed dry needling under 97140 and were

paid for it does not mean you were supposed to be paid for it. If that payor

reviewed your documentation and saw you were doing dry needling, would you keep

the money?

A perfect example is ice massage. Many providers were billing that under 97124

since they said they were doing massage. The AMA came out in August 2007 CPT

Assistant, I believe, and said ice massage is a component of 97010 (hot or cold

packs).

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

View upcoming audio conferences at http://www.gawendaseminars.com/news.aspx

Subject: RE: How are you charging for " Dry Needling " ?

To: PTManager

Date: Saturday, June 25, 2011, 9:15 AM

 

Anyone who bills an insuror must use CPT Codes. The AMA's CPT Code book

specifies in its beginning pages that the clinician must use the code which

*exactly* describes the technique they perform, not one which comes closest.

If a clinician is using a technique which is not *exactly* what is

stipulated in the CPT Code description, the instructions tell them to use a

code for Unlisted Procedure.

So, it is not like the SATs, where one selects an answer which " most nearly "

matches.

Unfortunately, we now live in an age where making an error can be construed

as fraud. We must be careful.

Dr. Dick Hillyer

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

700 El Dorado Pkwy W.

Cape Coral, FL 33914

Mobile

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Dr. Jan Dommerholt

Sent: Thursday, June 23, 2011 3:03 PM

To: PTManager

Subject: Re: How are you charging for " Dry Needling " ?

I have used dry needling for the past 16 years in my practice and teach the

technique all over the world. I believe that dry needling is a manual

therapy technique, which is supported by the position statement of the

American Academy of Orthopaedic Manual Therapists accepting dry needling as

a technique within the scope of manual physical therapy. Therefore, I

believe that the best code for dry needling is 97140.

There is controversy about how to bill for dry needling. Suggestions have

included neuromuscular education, therapeutic activity, and others. Fact is

that dry needling should not be a technique by itself but should always be

part of a more comprehensive treatment approach. In other words, I am not

sure that dry needling should be considered as a separate billable item, but

more as a technique within manual physical therapy practice.

Jan Dommerholt, PT, DPT, MPS, DAAPM

Bethesda PhysiocareR, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

+ (voice)

+ (fax)

dommerholt@...

<mailto:dommerholt%40bethesdaphysiocare.com>

www.bethesdaphysiocare.com

Myopain Seminars, LLC

+ (voice)

+ (fax)

www.myopainseminars.com

dommerholt@... <mailto:dommerholt%40myopainseminars.com>

http://www.linkedin.com/in/jandommerholt

[Guest guest]

What you may advocate versus what is the definition of manual therapy versus

what the insurance company tells you to do versus what APTA may recommend may

all be different. I'm speaking on the insurance perspective and feel confident

in my response. You and others need to get the AMA to clarify dry needling as a

component of manual therapy.

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

http://www.gawendaseminars.com

> Rick,

>

> I would disagree with you that dry needling, an instrument assisted manual

> therapy technique, should be coded as something that it is not. I have met

> numerous physical therapists, osteopaths, and chiropractors who utilize this

> technique, and not a single one of them has stated that they code this as

> 97799. Every one of them including those physical therapists who teach dry

> needling advocate on coding this manual therapy technique as a manual therapy

> procedure (i.e. CPT 97140).

>

> Sumesh , PT, , DPT, OCS

> Fellow of the American Academy of Orthopaedic Manual Physical Therapy

>

> ________________________________

>

> To: PTManager

> Sent: Mon, June 27, 2011 5:20:05 PM

> Subject: RE: How are you charging for " Dry Needling " ?

>

>

> Well said Dick. To me, dry needling is billed under 97799 until the American

> Medical Association (AMA) comes out in a CPT Assistant publication and tells

me,

> you, and others otherwise. Several payor policies address dry needling and

state

> it is non-covered. Just because you billed dry needling under 97140 and were

> paid for it does not mean you were supposed to be paid for it. If that payor

> reviewed your documentation and saw you were doing dry needling, would you

keep

> the money?

>

> A perfect example is ice massage. Many providers were billing that under 97124

> since they said they were doing massage. The AMA came out in August 2007 CPT

> Assistant, I believe, and said ice massage is a component of 97010 (hot or

cold

> packs).

>

> Rick Gawenda, PT

> President

> Gawenda Seminars & Consulting, Inc.

> www.gawendaseminars.com

>

> View upcoming audio conferences at http://www.gawendaseminars.com/news.aspx

>

>

>

>

> Subject: RE: How are you charging for " Dry Needling " ?

> To: PTManager

> Date: Saturday, June 25, 2011, 9:15 AM

>

>

>

> Anyone who bills an insuror must use CPT Codes. The AMA's CPT Code book

>

> specifies in its beginning pages that the clinician must use the code which

>

> *exactly* describes the technique they perform, not one which comes closest.

>

> If a clinician is using a technique which is not *exactly* what is

>

> stipulated in the CPT Code description, the instructions tell them to use a

>

> code for Unlisted Procedure.

>

> So, it is not like the SATs, where one selects an answer which " most nearly "

>

> matches.

>

> Unfortunately, we now live in an age where making an error can be construed

>

> as fraud. We must be careful.

>

> Dr. Dick Hillyer

>

> Dr. Hillyer, PT,DPT,MBA,MSM

>

> Hillyer Consulting

>

> 700 El Dorado Pkwy W.

>

> Cape Coral, FL 33914

>

> Mobile

>

> _____

>

> From: PTManager [mailto:PTManager ] On Behalf

>

> Of Dr. Jan Dommerholt

>

> Sent: Thursday, June 23, 2011 3:03 PM

>

> To: PTManager

>

> Subject: Re: How are you charging for " Dry Needling " ?

>

> I have used dry needling for the past 16 years in my practice and teach the

>

> technique all over the world. I believe that dry needling is a manual

>

> therapy technique, which is supported by the position statement of the

>

> American Academy of Orthopaedic Manual Therapists accepting dry needling as

>

> a technique within the scope of manual physical therapy. Therefore, I

>

> believe that the best code for dry needling is 97140.

>

> There is controversy about how to bill for dry needling. Suggestions have

>

> included neuromuscular education, therapeutic activity, and others. Fact is

>

> that dry needling should not be a technique by itself but should always be

>

> part of a more comprehensive treatment approach. In other words, I am not

>

> sure that dry needling should be considered as a separate billable item, but

>

> more as a technique within manual physical therapy practice.

>

> Jan Dommerholt, PT, DPT, MPS, DAAPM

>

> Bethesda PhysiocareR, Inc.

>

> 7830 Old town Road, Suite C-15

>

> Bethesda, MD 20814-2440

>

> United States

>

> + (voice)

>

> + (fax)

>

> dommerholt@...

>

> <mailto:dommerholt%40bethesdaphysiocare.com>

>

> www.bethesdaphysiocare.com

>

> Myopain Seminars, LLC

>

> + (voice)

>

> + (fax)

>

> www.myopainseminars.com

>

> dommerholt@... <mailto:dommerholt%40myopainseminars.com>

>

> http://www.linkedin.com/in/jandommerholt

>

>