1. Measuring and Managing Healthy Living Bioelectrical Impedance Analysis Technician

2. Measuring and Managing Healthy Living Statements and Indications For Use Brief background of Body Composition Assessment Proper BIA procedure Procedural Coding

3. Measuring and Managing Healthy Living PLEASE NOTE The content of this slide deck is for informational purposes only. BIA technology is not intended to prevent, cure, diagnose, or treat any particular disease state. BIA technology does not replace the educated judgment of a licensed health care professional.

4. Measuring and Managing Healthy Living Indications For Use The following outlines RJL Systems Indications of Use cleared by the FDA. Calculation and Historical Tracking of: ■ Actual Impedance ■ Actual Phase Angle (PA) ■ Actual Body Mass Index (BMI) ■ Estimated Body Fat (FAT) ■ Estimated Fat Free Mass (FFM) ■ Lean Dry Mass (LDM) ■ Estimated Total Body Water (TBW) ■ Estimated Intra-Cellular Water (ICW) ■ Estimated Extra-Cellular Water (ECW) ■ Estimated Basal Metabolic Rate (BMR) ■ Estimated Daily Energy Expenditure (DEE)

5. Measuring and Managing Healthy Living Indications For Use Intended Population: BC is intended only for use on normally healthy adults and adolescents age 3-94. The prediction equations used by the BC software assume that the person being tested has not had either arm or leg amputated. It is not intended to be used to diagnose, treat, or cure any disease or medical condition. Contraindications: No known contraindications exist. Warnings: The BC software provides body composition estimates based on the electrical characteristics measured by a Bioelectrical Impedance Analyzer (BIA). BIA works by introducing an alternating current (AC) signal into the body and then measuring how that signal is affected by the body. This device should not be used on subjects with any implanted electronic devices such as pacemakers or implantable cardioverter-defibrillators (ICD)’s.

6. Measuring and Managing Healthy Living Why is accurate Body Composition Assessment necessary? Weight loss is not always healthy. We need to know which components are changing: fat, lean dry mass, intracellular water…?

7. Measuring and Managing Healthy Living Evidence-based medicine requires evidence

8. Measuring and Managing Healthy Living A blood analysis tells us what is in the blood. BIA helps tell us what is in the body weight. We need the details! Photo Courtesy of COM SALUD

9. Measuring and Managing Healthy Living RJL BIA is used all over the world Integrated and Functional Medicine Preventive and Lifestyle Medicine Hospitals and Private Practice University and Military Research NASA, NOAA NIH CTCA Mayo Clinic, Cleveland Clinic, Harvard, Yale…

10. Measuring and Managing Healthy Living

11. How BIA works The small electrical current used in BIA reacts differently in the various compartments of the body (water, fat, lean mass, etc.)

12. Measuring and Managing Healthy Living BIA Protocol

13. Measuring and Managing Healthy Living BIA Protocol Sample Permission Form (modify for your needs) Recommendations to discuss with your physician Optimal Preparation Notations Standardized BIA Protocol

14. Sample Permission Form, 1 of 2 pages

15. RJL Bioelectrical Impedance Analysis for Body Composition

16. Measuring and Managing Healthy Living Recommendations to Discuss with your Physician Joint Replacements: OK to use Average Range comparisons. Do the procedure on the opposite side of the body, and make a notation. Limb Replacements: NOT OK to use Average Range comparisons. Do the procedure on the opposite side of body, and make a notation. Only make qualitative comparisons over multiple visits. Pregnancy: NOT recommended Medical Device Implants: NOT recommended (i.e. pacemaker, defib, medical pump,etc.)

17. Measuring and Managing Healthy Living Optimal BIA Protocol Preparation No alcohol 24 hours prior No caffeine 4 hours prior No exercise 4 hours prior Notate sauna or Bikram Yoga, etc. if within 24 hours Drink 2 glasses of water 2 hours prior Empty bladder and/or bowel prior to analysis If your patient varied from this Preparation, make a note on the Report for your practitioner

18. Measuring and Managing Healthy Living Standardized BIA protocol Remove sock, stocking, shoe, jewelry, and any objects from the electrode sites. Remove any therapeutic magnets, cellphone or other electronic devices.

19. Measuring and Managing Healthy Living Supine position on a flat surface – AMA definition Knees separated, with arms out 30 degrees from waist, palms down Standardized BIA protocol

20. Measuring and Managing Healthy Living Standardized BIA protocol “RED WIRE SET on the hand toward HEAD.”

21. Measuring and Managing Healthy Living Clean the 4 electrode sites with alcohol pad, and allow to dry (about 30 seconds) Standardized BIA protocol

22. Measuring and Managing Healthy Living The patient should have been lying supine position about 3-5 minutes (while you clean the electrode sites, apply the adhesive pads, and properly attach the device clips), to allow the fluids of the body to stabilize. Standardized BIA protocol

23. Measuring and Managing Healthy Living The BIA device will give you 2 measures you need to record: Reactance (Xc) energy storage and Resistance (R) energy dissipation BIA Measurements

24. Measuring and Managing Healthy Living Once the Resistance and Reactance data is accurately recorded, the procedure is complete. You may now remove and discard the adhesive electrodes. Electrodes are NOT reusable. Standardized BIA protocol

25. Measuring and Managing Healthy Living Accurately record pertinent patient data: Name and/or Patient I.D. (as directed by your practitioner) Height Weight Age Gender

26. Measuring and Managing Healthy Living Target Weight (software fills this in, but your practitioner may decide to override) Notations (limb replacement, or recent exercise, sauna, alcohol, surgery, etc.) Lab biomarkers: measurements, HgBA1C, Lipids, BP, etc. Reports can be stored or emailed as a pdf, and printed. You choose tables, graphs, and whether you want to print the Food & Fitness section or Average Ranges. BC 3.0 Software (MAC or PC) Report Options

27. Measuring and Managing Healthy Living Population Equation Set Options NHANES-III (General Population)NHANES-III (General Population) Most utilized, appropriate for a ‘typical’ person. If you have a “thin/fit/skinny” individual, your practitioner may consider the Athletic or Obese equation sets, as appropriate. New Pediatric (Ages 4 – 19; also validated for obese children) Mexican Adults (Male & Female ) Native Americans Obese (BMI > 30 ) Obese African American Athletic HIV All Body Types (BMI adjustable)

28. Measuring and Managing Healthy Living Awareness RJL BIA is supine position, as is defined by the American Medical Association.

29. Measuring and Managing Healthy Living CPT Code 0358T BIA Whole Body Composition, supine position, with interpretation and report

30. Measuring and Managing Healthy Living Awareness Non-supine BIA methods, such as hand-held or standing BIA methods are not eligible for the American Medical Association 0358T CPT Code.

31. Measuring and Managing Healthy Living Awareness Non-supine BIA methods may have compromised accuracy due to: -unstable central venous pressure -callouses on hands & feet -temperature and moisture variations on the palms of the hands -temperature and moisture variations on the bottoms of the feet

32. RJL Systems 33939 Harper Avenue Clinton Township, MI 48035 (800) 528-4513 www.RJLSystems.com Photo Credits: Sunrise – Santa Banta, Midday – Dreamstime.com, Sunset –David baker, Icons (page 9) –unrestrictedstock.com