Rehab

Balancing diabetic patients with fall prevention programs

Rehab Regs, May 15, 2003

Editor's note: The June 2002 Briefings on Outpatient Rehab Reimbursement and Regulations analyzed how prevention programs for potential fall sufferers can add revenue to your practice. Here, we continue this story by focusing on diabetic peripheral neuropathy (DPN) patients.

Craig Turtzo, president of Anodyne Therapy, LLC, in Tampa, FL, says DPN is peripheral nerve damage caused by diabetes. "It typically manifests itself by a stocking or glove-like feeling on the patient's legs or lower extremities," he explains. "It can be accompanied by very severe pain that eventually limits the patient's . in temperature."

Since patients with DPN can't feel their feet or the space around them, they lose their ability to feel where they are, thus impairing their balance, according to Turtzo. He cites published reports that patients with DPN, who are mostly elderly, are 15 times more likely to sustain a serious fall than a person withoutdiabetes.

There are very few drugs or procedures that can return sensation to the patient's feet. And surgical procedures, such as tarsal tunnel nerve decompression, risk failure because a diabetic foot is slow to heal, says Turtzo.

"None of these procedures are any good unless you can restore sensation in the patient's feet," he explains. "With the Anodyne Therapy System [ATS], we've treated patients who have lost sensation in their feet and reversed the condition."

Here's how the ATS works: A series of 16 diodes make up special pads that are mounted on therapy pads. Electricity is supplied to these diodes to make them luminous. Then, an infrared light penetrates the skin, improving microcirculation, increasing circulation, and reducing pain. This differs from electrical stimulation because it's a light therapy that is a nonthermal modality, says Turtzo.

Anodyne Therapy manufactures the ATS pads and provides them to more than 400 hospitals, physician offices, and therapy clinics nationwide.

Broaden your contact pool

Referrals are the lifeblood of most practices, and offering this service for DPN patients is like getting a transfusion. Why? Because you probably have not contacted the physicians that DPN patients ordinarily see.

The following is a list of these physicians:

  • Endocrinologists

  • Gerontologists

  • Internists

  • Podiatrists

When diagnosed with DPN, patients often see their general practitioner, who then refers them to one of these four doctors. Turtzo says contacting these other sources is easy.

Tip: Contact the physicians listed above and explain to them the outcome and benefits of ATS treatment. "I know of one endocrinologist who has sent 15 referrals over the last month and a half to a therapy clinic in Tampa," Turtzo says.

In most states, podiatrists aren't allowed to bill therapy codes. They understand their patients' problems, but they can't prescribe something like ATS. So let podiatrists know about the ATS program, and explain to them the pain they will save their patients.

Tip: Call local media to report the results you are getting with ATS. "We had one instance in Indiana where the local TV station came out and filmed a 30-second spot about what this clinic does with DPN patients and how it's correcting their balance issues," Turtzo explains. "They picked up 40 patients into their program within the next three days."

What you can do

PTs and OTs normally teach their patients compensatory strategies, such as how to use a cane. Stretching programs are also common. These target the hamstring, hip flexors, and the Achilles areas, which improve a patient's gait and balance.

But Turtzo says these strategies only do half the job.

For six years, Alan Kochman, MSPT, of The Medical Center of Aurora in Colorado, has used the technology. He incorporates the ATS pads into his daily practice. One use is with a machine called a Balance Master that helps with a patient's equilibrium.

"Before I was using infrared [with the Balance Master] my staff and I were excited about a 10% to 15% improvement rate in balance among the patients," he says. "Since then, we have upped that rate to 25% to 40%."

Before placing the pads on the feet and lower legs of a patient, the supervising therapist assesses the patient's physical impairments. For example, if the patient has lost flexibility in the hamstrings, prescribe the appropriate stretching. If the patient experiences muscle imbalance, use strengthening activities.

Editor's note: You can contact Craig Turtzo via e-mail at mediop@aol.com.

Exercises for diabetic peripheral neuropathy patients

Alan Kochman, MSPT, of The Medical Center of Aurora in Colorado, says to use the following exercises for diabetic peripheral neuropathy (DPN) patients:

  • Patients alternate between standing on their toes and then on the back of their heels. After they master that, ask them to rock back and forth.

  • With their backs toward the wall, tell the patients to stand a few inches away from a wall, having them lean back until their shoulder blades barely touch the wall. Then, instruct them to lean forward. When the patients master this exercise, move them a bit farther from the wall and continue the exercise. This strengthens the ankles.

  • Patients stand on an unstable surface, such as a pillow or a piece of foam.

  • Patients step over and around objects in an obstacle course.

  • Typical stretching exercises.

When using these exercises for your work with DPN patients, make sure the infrared system runs through the bottom of their feet. Because of this, Kochman suggests providing this service for 20 to 40 minutes before performing the exercises.

Getting paid for using ATS

Similar to other procedures, reimbursement for the use of the Anodyne Therapy System (ATS) treatment depends on what ails your patient.

Although there is no specific code for the treatment, your clinic can get paid for this service if you combine it with another code.

The course of treatment is typically one hour per treatment session, three times a week, for 12 to 16 treatments. Each billing session runs $97, according to Craig Turtzo, president of Anodyne Therapy, LLC, in Tampa, FL.

Bill for the therapeutic activity your patient needs, such as the following CPT codes:

  • 97110-Strengthening, range of motion,flexibility

  • 97112-Neuromuscular reeducation-movement, balance, proprioception

  • 97113-Aquatic therapy

  • 97116-Gait training

  • 97530-Therapeutic activities

  • 97533-Sensory integrative techniques

Or, you can bill one of the following codes for simply using ATS:

  • 97026-For infrared treatment

  • 97039-Unlisted physical modality

Source: Anodyne Therapy, LLC, Tampa, FL. Reprinted with permission.

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