- no message n/m by lisag
19 y
3,942 7 Messages Shown
Blog: journal - energy healing and liver flush
Turns out that colonic hydro therapists aren't licensed and shouldn't be putting diag codes on their receipts, so I've erased my note with the diag codes that were given to me (by my CHT).
Lisa
|
|
|
lisag
|
|
- Diagnostic and CPT Codes by UserX
19 y
1,724
Hi Lisag,
I'm glad to hear that you were able to receive reimbursement for your colonics.
However, unless your colon hydrotherapist is a medical practitioner...they are putting themselves in considerable jeapordy by stating a diagnosis and providing a CPT code. And most colon hydrotherapist won't...and shouldn't do this! Let me explain: a diagnostic code is an indication of a medical condition and a CPT code is an indication of the treatment for that condition. If these codes are used it implies that the person making the determination is a medical practitioner. Any colon hydrotherapist (who is not also a medical practitioner) is in danger of being charged with practicing medicine without a license which is a felony offense.
Colon hydrotherapists should never diagnose or even imply that they are providing 'treatment'. Doing so not only puts the individual CHT in danger, but could also potentially put the entire practice of colon hydrotherapy in jeapordy! Some CHTs will even avoid using the term 'therapist' as they feel like they're walking a thin line on this same issue...they call themselves colon irrigationists instead. As with many alternative/complementary practices...there are plenty of folks in the medical professions that would welcome the opportunity to eliminate these practices altogether or take control of them for their own use. When CHTs provide diagnostic and CPT codes they're giving the medical community just the kind of ammunition they need to 'justify' why this practice should not be allowed or only administered by a licensed medical practitioner.
It is not my intention to contradict you or be argumentative. As a CHT myself, I've just heard too many stories of federal agents confiscating colon hydrotherapy equipment and closing down practices for much lesser 'offenses'...so I know the threat is a very real one, both to the individual CHT and to the profession as a whole.
|
|
|
|
- Re: Diagnostic and CPT Codes by lisag
19 y
1,781
While I appreciate your note, I don't agree with you - and neither does the insurance company. Before posting my note, I called them, and went up the ladder to verify it.
The insurance company has a list of procedure codes, and a separate list of diagnosis codes. In order to get paid, the procedure code and a diagnosis code must 'match.' you couldn't get paid on a procedure code of 'massage therapy' with a diagnosis code of 'tooth pain.' The fact that the procedures MATCH the diagnoses - massage therapist & back pain, colonic therapy & IBS, speech therapy & lisp, etc., is the key here. Obviously if the colonic therapist wrote down 'colon surgery' and 'IBS' they'd be in big trouble. But 'colon therapy' and 'IBS' are an appropriate match, nobody gets in trouble, and you get paid.
As I said in my note, the insurance company requires a diagnosis code in order to pay on the claim. It is not used for any other purpose. When you go to a massage therapist, if they put 'back pain' as a diagnosis, then if your insurance covers massage therapy, they will pay. If your insurance company covers massage therapy, but your massage therapist doesn't put 'back pain' or an equivalent as a diagnosis code, the insurance company will not pay.
While I understand where you're coming from - alternative practicioners get in trouble for 'diagnosing' and 'treating' medical conditions that doctors want to be the only knowledge base on, this is not at all the same thing.
|
|
|
lisag
|
|
- Re: Diagnostic and CPT Codes by lisag
19 y
1,870
While I appreciate your note, the insurance company disagrees with you. Before posting my note, I called them, and went up the ladder to verify it.
The insurance company has a list of procedure codes, and a separate list of diagnosis codes. In order to get paid, the procedure code and a diagnosis code must 'match.' you couldn't get paid on a procedure code of 'massage therapy' with a diagnosis code of 'tooth pain.' The fact that the procedures MATCH the diagnoses - massage therapist & back pain, colonic therapy & IBS, speech therapy & lisp, etc., is the key here. Obviously if the colonic therapist wrote down 'colon surgery' and 'IBS' they'd be in big trouble. But 'colon therapy' and 'IBS' are an appropriate match, nobody gets in trouble, and you get paid. This is what the insurance company has said.
You mention that colon hydrotherapists have been shut down for lesser 'offenses' than this. Just curious to know what offenses they have been shut down for. Can you fill me in?
Thanks,
Lisa
|
|
|
lisag
|
|
- Re: Diagnostic and CPT Codes by lisag
19 y
1,870
P.S. Obviously you're correct about CHT's being harassed, shut down, etc, and I'm curious to know how they've been put out of business - which is rotten. But about how the whole cpt/diagnosis code thing works - I'd be surprised if the insurance company was wrong.
When I went to a physical therapist, I received a diagnosis of "tmj" and "cranial dysfunction. When I went to a chiropractor, I received a diagnosis of "subluxation." When I went to a massage therapist, I received a diagnosis of "back pain." In each case the practicioner was licenced to give a diagnosis that fell within their area of expertise. They were licensed to give those diag codes out. The only thing I didn't do to verify how that whole thing works the way the insurance company said is call a licensing board. If you contact a licensing board for CHT, chiropracting, Physical Therapists, etc., and find out that United Healthcare is incorrect, please let me know. Meanwhile I will do so, but since I'm not a licenced practicioner of any sort, I don't know how far I'm going to get. I would be happy if you could shed more light on it.
I have heard of people getting shut down for practicing medicine without a license, not for giving diagnois codes that fall within their licensing. The problem with herbalists is that they are not licensed to give any diagnosis at all, whatsoever, so of course they get in trouble (which is totally messed up, in my opinion).
Again you are the person with the experience here, so please provide more info. If you find out from a licensing bureau that United Healthcare is incorrect, please email me immediately and I'll make sure I take down the note. And that's horrible that CHT's were put out of business for any reason, and I'm curious to know what the reasons were.
|
|
|
lisag
|
|
- Re: Diagnostic and CPT Codes by UserX
19 y
1,974
I'm short on time so this will not be as thorough as I would like it to be...but I wanted to give you a response and a few links. You should be able to connect some dots from reading the info on those sites. I'll give you the bare-bones outline of the issue:
Some insurance companies WILL cover colon hydrotherapy with the proper Dx and CPT codes. Their job is to reimburse for any covered conditions...not to police who is providing the codes. If the codes are provided, from the insurers standpoint there is no problem.
The problem comes in at the level of professional regulations.
Florida is the ONLY state that licenses colon hydrotherapists! Colon hydrotherapy is virtually an unregulated profession. While CHTs will refer to themselves as 'certified'...this is meaningless as far as any governing body is concerned. Colon hydrotherapist are not operating within their jurisdiction if they are diagnosing and treating a medical condition. (Florida MAY be an exception to this since they are licensed, but it wouldn't surprise me if they weren't...I don't know for certain.)
If you research various colon hydrotherapist's websites...or go to them for a colonic...the vast majority of them will include a disclaimer in the info they provide or on the consent form that they require you to sign. (The smart ones will do this!) This disclaimer will generally state that they do not diagnose, prescribe, treat...blah, blah, blah...any medical condition, and it will refer you to consult with your physician. Here's a link to one such site...check out 'Insurance' and 'Disclaimer'. They do this to protect their butts because they know that if they step over that fine line...they're out of business and may be facing felony charges.
http://www.sheilas.com/office.html
Now, here's where another problem comes in...colon hydrotherapists have been advised by I-ACT to use FDA approved equipment for performing colonics. The International Association for Colon Hydrotherapists (I-ACT) is the largest professional organization for CHTs, although it is self-regulated and has no government affiliation. They are attempting to set standards for CHTs...partly in the hope that they can garner some political muscle and protect the profession. This is not a bad thing...but it has also created a new problem.
The FDA classifies colonic equipment (including disposable speculums and tubing) as Class II or III medical devices...depending on the intended use. Consequently the purchasing and use of this equipment 'should' be done &/or supervised by a licensed health care provider. CHTs/equipment manufacturers have been able to get around this somewhat...they simply obtain/provide a 'prescription' for the equipment...and all sorts of disclaimers. CHTs are 'supposed' to have a prescription from a licensed healthcare provider for each and every colonic they perform with that FDA approved equipment! Obviously, in most cases this doesn't happen and most CHTs get away with it. Most...but not all!!!
I know of at least two clinics that were raided...equipment seized, doors locked, and charges filed...simply because the facilities did not have prescriptions for all their booked colonics and there was no licensed healthcare practitioner supervising the use of the colonic equipment...FDA approved medical device. (These are the lesser offenses I referred to in my previous post.) Mind you, no one had been harmed...no complaints had been filed by clients...they just cracked down on them BECAUSE THEY COULD!!!
Here are a couple of links that should give you a better idea of what I mean...
http://www.oag.state.tx.us/oagnews/release.php?id=295
http://72.14.207.104/search?q=cache:8kMj9dJdslsJ:www.oag.state.tx.us/newspubs/releases/2003/hydro6.pdf+medical+device+classification+colon+irrigation&hl=en&client=safari
I hope this info has helped you to understand the situation better and also the reason for my post. I didn't mean to rain on your parade...just wanted to fill you (and other readers) in on the potential consequences to CHTs and the profession as a whole.
I went through an I-ACT approved training program and I am a certified CHT. During my training we were repeatedly cautioned against diagnosing, 'treating'...or even implying in the slightest way that we were doing so (ie. clients, NOT patients). Bottom line...it's a real sticky web, CHTs are walking on thin ice as it is, and they shouldn't do anything that might raise an eyebrow or draw 'special' attention to themselves.
And, yep...it sucks!!!
*You might want to pass this info along to your CHT...who may not even be aware of what s/he could possibly be stepping in!!!
|
|
|
|
- Re: Diagnostic and CPT Codes by lisag
19 y
2,143
Thanks for writing, I didn't know that CHT's weren't licensed - (I knew people who had gone to school for it, so I assumed that a license went along with the schooling). That does change things, unfortunately for the worse. If they were licensed I assume this couldn't happen... I will talk to the CHT therapist that I use.
Lisa
|
|
|
lisag
|
|
|
|
CureZone