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StretchZone | The Clinical SideTodd M. Narson, DC, DACBSP, ICSSD

What’s Out There?1. Static2. Contract-Relax / Progressive Resistance / PNF3. PFS – (Janda)4. Active-Assisted5. Active Isolated Stretching (Aaron Mattes)6. Etc..etc..etc…

Pros1. All good techniques that work for various conditions2. Each focuses on different aspect of stretching

a. Physically Stretch adhesions/scarsb. Trying to beat the muscle spindle/golgi tendon responses to achieve greater ROM

Cons1. No consideration for practitioner position/ergonomics

a. Lifting heavy body parts & holding for ??? amount of timeb. Trying to secure body parts with your leg, or other hand or compensation for change of body positionc. 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

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.

First Things FirstEstablishing Medical Necessity

1. Examination – Determine need, medical necessity and which code fits best

a. Where it all startsi. Rule out contraindications ii. Identify specific problemsiii. Decide which stretches and stretching patterns best

suit the patient iv. Which code best fits how you will be treating the

patient?

First Things FirstEstablishing Medical Necessity

2. Stretching Fora. Acute Phase

i.Influencing the orientation of healing scarsb. Subacute Phases

i. Continued influencing of healing scar as they matureii. Increasing ROM & Flexibility

c. Rehab Phasei. Improve functional performance

First Things FirstEstablishing Medical Necessity

3. Proving Medical Necessity– What Is Your Goal For The Procedure? Why Are You Doing it???

a. Strain to tendons & ligamentsb. Loss of ROMc. Loss of flexibilityd. Loss of strengthe. Loss of endurancef. Muscle spasms and/or hypertonicityg. Acute and/or Chronic joint dysfunction (ligament and/or

capsular strain)

First Things FirstEstablishing Medical Necessity

4. DocumentationBe specific with:

i. Names of muscles, tendons, jointsii. Names of function (loss of or reduction of…)

1. Hip flexion2. Knee flexion3. Shoulder external rotation4. Internal-External Rotation of the Shoulder5. Cervical lateral flexion, rotation and extension

First Things FirstEstablishing 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 painiv. Postural Alterations

1. Upper crossed syndrome2. Lower crossed syndrome3. Layered crossed syndrome4. Scoliosis5. Must Establish Medical Necessity For Any Procedure-Not Just Stretching

CPT Coding for Reimbursement1. 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

stretching3. All constant attendance modalities are billed in 15 minute time units4. 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 room2. Patient undressing/gowning3. Updating day-to-day history4. Reassessing their ROM prior to the stretching5. 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 Unite. Health insurers (BCBS, Aetna, etc) will pay partial unit time for -52 modifier codes.

CPT Coding for ReimbursementMedicare’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 dayIf 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 Unit23-37 minutes = 2 units38-52 minutes = 3 units53-67 minutes = 4 units68-82 minutes = 5 units

CPT Coding for ReimbursementUnder New PIP Law – No More 97124.97124 = RVU .59 1. 97140 – Joint and/or Soft Tissue Mobilization (RVU=.70)

Mobilization, manipulation, lymphatic drainage, manual tractionUse StretchZone Methods 8-to-55-min protocol = 1-4 Units

2. 97110 – Therapeutic Exercises / Procedures (RVU=.74)To develop (1 of) the following:

StrengthEnduranceROMFlexibility

Use StretchZone Methods 8-to-55-min protocol = 1-4 Units

CPT Coding for Reimbursement3. 97530 – Therapeutic Activities (RVU=.78)To develop 2 or more of the following, related to specific functional activities:StrengthEnduranceROMFlexibilityUse StretchZone Methods 8-to-55-min protocol = 1-4 Units

???Who Still Needs 97124???

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 412Miami Beach, FL 33140