1. Logo Stretch Back the Years tm StretchZone | The Clinical Side Todd M. Narson, DC, DACBSP, ICSSD

2. What’s Out There? 1.Static 2.Contract-Relax / Progressive Resistance / PNF 3.PFS – (Janda) 4.Active-Assisted 5.Active Isolated Stretching (Aaron Mattes) 6.Etc..etc..etc…

3. Pros 1.All good techniques that work for various conditions 2.Each focuses on different aspect of stretching a. Physically Stretch adhesions/scars b. Trying to beat the muscle spindle/golgi tendon responses to achieve greater ROM

4. Cons 1.No consideration for practitioner position/ergonomics a. Lifting heavy body parts & holding for ??? amount of time b. Trying to secure body parts with your leg, or other hand or compensation for change of body position c. Leads to injury-strain 2.No system for using the patient/client’s body for mechanical advantage 3. No system to secure the patient/client to reduce extraneous movements and truly isolate individual muscles/groups and movements

5. The Stretch Zone Method® Position: Position the patient for a series of related stretches Stabilization: Stabilize the patient to take advantage of the patients body weight to give the practitioner mechanical advantage, reducing the physical stress & workload Isolation: Allows the practitioner to isolate the muscle, muscle group or movement without extraneous patient movement Progression: Common sense-easy progressions to make the stretches flow together as you stretch a system. Universal: Stretch Zone system of position, stabilization, isolation and progression can be effectively used with ANY system of stretching.

6. First Things First Establishing Medical Necessity 1. Examination – Determine need, medical necessity and which code fits best a. Where it all starts i. Rule out contraindications ii. Identify specific problems iii. Decide which stretches and stretching patterns best suit the patient iv. Which code best fits how you will be treating the patient?

7. First Things First Establishing Medical Necessity 2. Stretching For a. Acute Phase i.Influencing the orientation of healing scars b. Subacute Phases i. Continued influencing of healing scar as they mature ii. Increasing ROM & Flexibility c. Rehab Phase i. Improve functional performance

8. First Things First Establishing Medical Necessity 3. Proving Medical Necessity– What Is Your Goal For The Procedure? Why Are You Doing it??? a. Strain to tendons & ligaments b. Loss of ROM c. Loss of flexibility d. Loss of strength e. Loss of endurance f. Muscle spasms and/or hypertonicity g. Acute and/or Chronic joint dysfunction (ligament and/or capsular strain)

9. First Things First Establishing Medical Necessity 4.Documentation Be specific with: i. Names of muscles, tendons, joints ii. Names of function (loss of or reduction of…) 1. Hip flexion 2. Knee flexion 3. Shoulder external rotation 4. Internal-External Rotation of the Shoulder 5. Cervical lateral flexion, rotation and extension

10. First Things First Establishing Medical Necessity 4.Documentation (continued) iii. Relate to ADL function (work, life, sports) 1. Restricted/Improved ability to rotation neck/upper back to look over shoulders for changing lanes while driving. 2. restricted/improvement in ability to reach forward while washing dishes/mimicking working on an assembly line 3. Restricted/improved ability to flex/extend hip while walking/running/climbing stairs with reduced level of pain iv. Postural Alterations 1. Upper crossed syndrome 2. Lower crossed syndrome 3. Layered crossed syndrome 4. Scoliosis 5. Must Establish Medical Necessity For Any Procedure-Not Just Stretching

11. CPT Coding for Reimbursement 1.StretchZone stretching is a direct one-on-one constant attendance therapy. 2.Reimbursement can be requested under several CPT codes depending on the focus of the stretching 3.All constant attendance modalities are billed in 15 minute time units 4.If less than one unit of time is performed, you must use a -52 modifier to alert the insurance company than less than 1 full unit of time was performed. 5.Constant attendance modalities may have a pre and post service time component associated with the delivering of the service. a. Pre-service time component is the time it takes you to prepare the patient for the actual service and may include: 1. Once patient enters the treatment room 2. Patient undressing/gowning 3. Updating day-to-day history 4. Reassessing their ROM prior to the stretching 5. Adjusting the patient on the exam/treatment table readying them for the treatment b. You can bill a partial unit of time as a pre-service component to the main service. c. Pre-service billed with -52 modifier (most PIP insurers will pay for full unit) d. If pre-service is 7-min and “service” (aka StretchZone stretching) is 8-min = 1 Unit e. Health insurers (BCBS, Aetna, etc) will pay partial unit time for -52 modifier codes.

12. CPT Coding for Reimbursement Medicare’s “8” Minute Rule – The Gold Standard Only for CPT Codes time in 15 minute increments (1 Unit) Total Treatment Time determines how many 15 minute units can be charged in a single day If one 15 minute Timed Treatment is performed for LESS than 7 minutes it doesn’t count; If two different 15 minute Timed Treatments are performed for 7 minutes or less on the same day and their total is >8 minutes you will bill for 1 unit of the treatment that lasted the longest “8” Minute Rule Guidelines for Time Based Codes of 15 minute Units (KEY: 15+8=$) 8-22 minutes = 1 Unit 23-37 minutes = 2 units 38-52 minutes = 3 units 53-67 minutes = 4 units 68-82 minutes = 5 units

13. CPT Coding for Reimbursement Under New PIP Law – No More 97124. 97124 = RVU.59 1. 97140 – Joint and/or Soft Tissue Mobilization (RVU=.70) Mobilization, manipulation, lymphatic drainage, manual traction Use StretchZone Methods 8-to-55-min protocol = 1-4 Units 2. 97110 – Therapeutic Exercises / Procedures (RVU=.74) To develop (1 of) the following: Strength Endurance ROM Flexibility Use StretchZone Methods 8-to-55-min protocol = 1-4 Units

14. CPT Coding for Reimbursement 3. 97530 – Therapeutic Activities (RVU=.78) To develop 2 or more of the following, related to specific functional activities: Strength Endurance ROM Flexibility Use StretchZone Methods 8-to-55-min protocol = 1-4 Units ???Who Still Needs 97124???

15. Stretch Zone 786.302.8039 Todd M. Narson, DC, DACBSP®, ICSSD* Specializing in the Treatment of Sports Injuries 400 Arthur Godfrey Road (41st Street) - Suite 412 Miami Beach, FL 33140