Opening your door to a Pain Management practice with the latest technology… Next Slide

Opening your door to a Pain Management practice with

the latest technology…

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Opening your door to a Pain Management practice and

making it part of your future.

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© Copyright 05/2005 NeuroMed Consulting, Inc. All rights reserved. Printed in the United States of America.

No part of this material may be used or reproduced in any manner whatsoever without written permission.

Next SlideRev: 03-13-07

NOTE:The information contained in this presentation is only to be used as a guide to assist a physician in a clinical practice and/or procedures. This information should not be interpreted solely on its own merits but should be used in conjunction with patients history, progress notes, diagnostic tests, and evaluations. Physician should always review manufacture’s instruction manual for full warnings, precautions, and contraindications before using medical device.

While the contributing authors have taken care to present the material in an accurate and complete manner, neither NeuroMed Consulting, Inc., the authors nor the publisher accept any responsibility or liability for errors, misuse, misinterpretations, or omissions. There might be noticeable differences between geographic areas, device manufacturers, or individual discretion on the correct applications for a given medical condition. NeuroMed Consulting, Inc. recommends that the physician consult with their individual manufacturer, regulatory agency, and/or medical association for the best treatment for any diagnosis that patients may present.

NeuroMed Consulting, Inc.

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Opening the door with NeuroMed

A Business Opportunity

Is this new Technology?

The History…

What is an Electroanalgesia ?

The Theory…

INDICATIONS

CONTRAINDICATIONS

What are the most common CPT codes

Some ICD-9 codes used by physicians in Pain Management

Who is using this advanced electroanalgesic technology…

NeuroMed’s Pain Management program

NeuroMed Consulting, Inc. Mission Statement:

NeuroMed Consulting, Inc. will lead the industry in the field of Pain Management by providing physicians and their patients with the latest in medical diagnostic equipment, Electroanalgesic treatment science and technology in the treatment and diagnosis of pain.

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We are here to serve our customers!

In today's rapidly changing healthcare environment, it is wise for healthcare providers to explore avenues of practice diversification to help create more comprehensive services for their patients.

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With declining medical reimbursements and increasing operating expenses, many practitioners have watched their income erode.

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In an effort to compete in today's healthcare arena, many physicians have discovered electroanalgesic medicine for the treatment for pain.

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However, due to the frequent changes in reimbursements by insurance companies, without the right tools or training, Pain Management treatments can be frustrating, time-consuming, and unprofitable.

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Utilizing our physical medicine and electroanalgesic treatment devices, NeuroMed can help you to overcome these obstacles.

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The following is a condensed description of

our services.

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NeuroMed will provide the clinical professional with the optimum level of comfort and confidence in electroanalgesic medicine by supplying supporting research and clinical documentation.

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NeuroMed will completely train selected members of your staff in the field of physical medicine and the physician is trained in electroanalgesic treatment procedures and application. We will also conduct continued education seminars for the physician and the staff.

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NeuroMed will assist the business manager with reimbursement and coding issues from third-party insurers.

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The benefits of our program include:

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The benefits of our program include:

Non-toxic, safe, and effective Pain Management treatment

Easy to administer pain procedures, many by existing staff

Complete training provided for billing manager and staff

Alternative or adjunctive clinical treatment

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An ongoing relationship with NeuroMed will keep you up to speed with the latest enhancements in Pain Management as we develop them for the marketplace.

We look forward to serving you in the near future.

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You can bring state-of-the-art technology to your practice, offer a proven beneficial service to your patients, and expand your opportunities for practice growth with NeuroMed electroanalgesic systems. This advanced technology is quickly becoming a highly praised and integral element in the treatment protocols of successful clinics and practices across the country.

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Electroanalgesic treatments are used by such institutions as the Bethesda Naval Hospital, the Cleveland Clinic in Ohio, the King/Drew Medical Center in Los Angeles, and the Loma Linda University Medical Center, as well as by over 2,500 practicing physicians across the U.S., the NeuroMed electroanalgesic systems may be the answer for assisting your patients who seek relief from acute, post-traumatic, post-surgical, or chronic pain.


Is This New Technology?

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A NEW TECHNOLOGY?

Although electromedicine may seem like a new technology to many practitioners, it is actually one of the oldest and most documented medical sciences known. Cellular function has long been known and accepted to be influenced by specific bioelectric fields.

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A NEW TECHNOLOGY? The science of clinical electromedicine and

electroanalgesic treatment is based upon the concept that any medical therapy, regardless of the specialty or avenue of approach, can only stimulate, facilitate, or inhibit electrical or chemical processes in the body.

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Is this a T.E.N.S unit? (Transcutaneous Electric Nerve Stimulation)

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Electroanalgesia is not like a T.E.N.S. home unit!

Electroanalgesia should not be confused with a T.E.N.S. unit. Many physicians and insurance companies think of a T.E.N.S. unit as an external small device that patients take home to reduce pain by applying low voltage electricity with adhesive electrodes placed over the skin.

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Electroanalgesic is not T.E.N.S. home unit!

An Electroanalgesia on the other hand is a clinical medical device used by a medical physician that uses an advanced computer assisted High Definition frequency generator (HDfg) ™ with high intensity frequency impulses to trigger nerve fibers to block pain signals to the brain.

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T.E.N.S. units use signals to produce repeated action potentials normally ranging upwards from 1 to 250 pulses per second. These signals imitate the normal firing frequencies of the nerves. The most typical range is usually from 1 to approximately 10 pps. T.E.N.S. units are considered to be a topical or peripheral nerve stimulator.

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Unlike a T.E.N.S. unit, an Electroanalgesia replaces areas of intense pain with a more pleasant sensation. Most patients say that it feels like a "light tingling" or "massaging sensation."

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More importantly, it masks the pain that is normally present. This sensation, called paresthesia, remains relatively constant during the treatment and should not hurt.

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T.E.N.S. effects in bioelectric procedures and treatments are biophysiological effects that are induced by repeated synchronous action potentials in excitable cells (1 to 250 pps -- pulses per second). This involves membrane depolarization and repolarization activity. (“Gate control theory of Pain”, Science 150., 1965;

Melzack and Wall)

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Electroanalgesia uses signals that are so fast that they cannot be physiologically followed by the nervous system (multiple stimulations falling within the absolute refractory period of the cell membrane). This depolarization effect is accomplished by using an advanced computer assisted High Definition frequency generator (HDfg) ™ to reduce the hyper-irritated state of the nerves.

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These signals must be faster and are used for stopping or interrupting the axon transport of the action impulse. Blocking the pain signal is necessary in cases of heavy (severe) pain. (Wendensky Inhibition)


What is an

Electroanalgesia ?

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Electroanalgesia (elec·tro·an·al·ge·sia)

Electroanalgesia (elec·tro·an·al·ge·sia) is defined by Stedman's Medical Dictionary,2nd Edition as:

“Analgesia that is induced by thepassage of an electric current.”

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Electroanalgesia (elec·tro·an·al·ge·sia)

Electroanalgesia is also defined by Dorland's Medical Dictionary

“The reduction of pain by electrical stimulation of a peripheral nerve

or the dorsal column of the spinal cord.”

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The History…

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THE HISTORY OF ELECTROMEDICINE

A wide variety of medical conditions have been successfully treated with electrical stimulation for nearly 2,000 years. Electro medicine gained wider acceptance in our day when Canadian psychologist Ronald Melzack and British physiologist Patrick Wall published their influential findings on the “Gate Control Theory of Pain”. (Science 150, 1965)

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These scientists found that certain cells in the spinal cord act as gates through which pain signals travel to the brain. Overloading these neural transmitter cells will block the naturally occurring electrochemical pain impulses and thus relieve pain.

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The Gate Control Theory was accepted by the medical community and helped establish the use of transcutaneous electric nerve stimulation (T.E.N.S.) in the United States.

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Since that time, NeuroMed Consulting, Inc. has refined and perfected electromedical processes to the point where comprehensive electroanalgesic medicine has emerged as an important adjunct discipline in the management and control of pain.

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NeuroMed provides the clinical profession with the optimum level of confidence in electromedicine and electroanalgesic medicine by supplying practitioners with high quality equipment, accessories, and related training and client services.


THEORY OF ELECTRO MEDICINE

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CLASSIFICATIONS

At present, there are two distinct electro medicine classifications:

(1) Action Potential (depolarization and repolarization)

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CLASSIFICATIONS

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CLASSIFICATIONS

At present, there are two distinct electro medicine classifications:

(1) Action Potential (depolarization and repolarization)

(2) No Action Potential (sustained depolarization):

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CLASSIFICATIONS

Action Potential

These effects in bioelectric procedures and treatment are biophysiological effects that are induced by repeated synchronous action potentials in excitable cells (1 to 250 pps -- pulses per second). This involves membrane depolarization and repolarization activity.

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Szasz Slide 31

Created by Prof. Szasz

Changes in conductance of sodium and potassium ion channels when the membrane potential is suddenly increased from the normal resting value of -90mv to a positive value of +10mv for 2 milliseconds. This figure illustrates that the sodium channels open (activate) and then close (Inactivate) before the end of the 2 milliseconds whereas the potassium channels only open (activate).

Guyton C.A. (1986)

Membrane potential

TIME (Milliseconds)

-90mv -90mv+10mv

Na+ channel K+ channel

CO

ND

UC

TA

NC

E(m

mh

o / c

m2 )

-90 mV -90 mV+10 mV

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CLASSIFICATIONS

No Action Potential

These effects in bioelectric procedures and treatment are biophysiological effects that are induced without action potentials (i.e., faster than 2,000 pps). This involves sustained depolarization – that is, no repetitive membrane depolarization and repolarization activity.

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Szasz Slide 37

Created by Prof. SzaszNext Slide

AFFECTING THE NERVEWITH ELECTROMEDICINE 1. NEURON FUNCTION IMITATION*

These are signals producing repeated action potentials normally ranging up wards from 1 to 20 or 30 pulses per second. These signals imitate the normal firing frequencies of the nerves. The most typical range is usually from 1 to approximately 10 pps, used primarily for adjunctive treatment of post-traumatic pain syndromes, prevention or retardation of disuse atrophy, adjunctive treatment in the management of post-surgical pain problems, and immediate post-surgical stimulation of the calf muscles to prevent phlebothrombosis.

*These mechanisms of action are only theory and have not yet been proved with valid scientific data.

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Szasz Slide 56


A, A resting neuron.

B, A neuron in an excited state, with increased intraneuronal potential caused by sodium

influx.

C, A neuron in an inhibited state, with decreased intraneuronl

membrane potential caused by potassium ion efflux and chloride

ion influx.

-70 mV

-45 mV

-65 mV

Guyton C. A. (1986)

Three states of a neuron

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AFFECTING THE NERVEWITH ELECTROMEDICINE 2. NEURON FUNCTION EXHAUSTION*

These are signals that produce repeated action impulses at a higher rate. This range of frequencies is normally from approximately 30 pps to 250 pps. Neuron exhaustion occurs in a relatively short time via the depletion of the synaptic neurotransmitter necessary for continued action potential propagation. This type of stimulation produces vasodilatation, muscle fatigue, and relaxation for spasm relief.


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Szasz Slide 56




influx.



ion influx.

-70 mV

-45 mV

-65 mV

Guyton C. A. (1986)


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AFFECTING THE NERVEWITH ELECTROMEDICINE

3. NEURON FUNCTION INTERRUPTION*

These are signals that are so fast that they cannot be physiologically followed by the nervous system (multiple stimulations falling within the absolute refractory period of the cell membrane). These signals must be faster than 2,000 pps and are used for stopping or interrupting the axon transport of the action impulse. Blocking the pain signal is necessary in cases of heavy (severe) pain.


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Szasz Slide 56




influx.



ion influx.

-70 mV

-45 mV

-65 mV

Guyton C. A. (1986)


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PAIN RELIEVING EFFECT

AS A PRIMARY EFFECT:*

Counter-irritation by means of action potential generation synchronous to the modulation frequency (beat frequency or pulse per second frequency; gate control theory; Melzack and Wall, et al).


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PAIN RELIEVING EFFECT

AS A PRIMARY EFFECT:*A block of the transmission of pain information by means of sustained reactive depolarization in the region of the higher intensity unmodulated middle frequency (Mf) electric field. (The resulting continuous refractory state is called Wendensky Inhibition.)


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PAIN RELIEVING EFFECT*

AS A SECONDARY EFFECT RESULTING FROM ALL THE OTHER PARTICULAR THERAPEUTIC PROPERTIES:

Motor nerve, muscle activation and stimulation

Increase of local blood flow

Local circulation

Effects on muscle

Biological influence


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Secondary PainRelieving Effects*

1. MOTOR NERVE AND MUSCLE STIMULATION

*These mechanisms of action are only theory and have not yet been proved with valid scientific data .Next Slide



Action potential generation in motor nerves and/or muscle cells synchronous to the modulation frequency (beat frequency, pulses per second frequency), with low frequency single twitches or tetanic contractions dependent on the modulation frequency (direct and indirect muscle stimulation).

*These mechanisms of action are only theory and have not yet been proved with valid scientific data. Next Slide



Physiological muscle contracture during distinct superthreshold simulation with sustained unmodulated middle frequency currents (direct muscle fiber stimulation).




Generation of spontaneous action potential activity with statistically distributed intervals between the single action potentials in nerves and muscle cells during stimulation with sustained unmodulated middle frequency currents moderately above motor threshold or in the range of motor threshold intensity (direct and indirect muscle stimulation).


SECONDARY PAIN RELIEVING EFFECT

2. INCREASE OF LOCAL BLOOD FLOW*

Effect of motor nerve and muscle stimulation with an increase in metabolism, followed by auto regulatory vascular mechanisms resulting in a decrease of local peripheral resistance of the vasculature in the stimulated muscle.


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CO2, lactate, and adenosine are end-products of metabolism. The auto regulatory vascular mechanisms are controlled by CO2, lactate (pH decrease), and adenosine release.

*These mechanisms of action are only theory and have not yet been proved with valid scientific data.Next Slide



ATP consumption is initiated by depolarization of both excitable and non excitable cells, because the cells try to repolarize their membrane potential. For this purpose they need ATP as the source of energy.

Electromedical currents depolarize excitable and non-excitable cells.


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SECONDARY PAIN RELIEVING EFFECT 3. LOCAL CIRCULATION*

Increase in the distribution of electrically charged substances (ions) and water Electro-osmosis within the tissue, resulting in:


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Dilution of toxic, pain, and/or inflammation causing substances

Increase of tissue clearance (filtration and diffusion processes)

Increasing local blood circulation Improvement of exchange (diffusion) processes:

the intro and extracapillary fluids Improvement of resorption processes,

important for prevention or retardation of disuse atrophy


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4. EFFECTS ON MUSCLE*

Motor nerve and muscle excitation followed by:

Relaxation of muscle spasms (comparable to theeffect of post-isometric muscle relaxation)

Interrupting the vicious cycle of pain


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5. BIOLOGICAL INFLUENCE*

Increase of the mitosis rate of germinative cells within tissues having regenerative functions


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Effect on non excitable cells by depolarization of the resting potential:


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5. BIOLOGICAL INFLUENCE* Effect on non excitable cells by depolarization of

the resting potential: A reversible increase in the electrical membrane

resistance takes place after a certain latency period. This is a stimulation for mitosis

*These mechanisms of action are only theory and have not yet been proved with valid scientific data.Next Slide


5. BIOLOGICAL INFLUENCE* Effect on non excitable cells by depolarization of

the resting potential: A reversible increase in the electrical membrane

resistance takes place after a certain latency period. This is a stimulation for mitosis

The consumption of ATP is increased due to the tendency of the cell to rebuild the resting potential. Repolarization is realized with the aid of the potassium pump. The energy needed for this is obtained from ATP hydrolysis.


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One end-product of the ATP consumption is adenosine, which:

Penetrates the cell membrane and acts as a strong local vasodilator

Causes an activation of cyclase, resulting in the generation of the substance cAMP (cyclic adenosine monophosphate) and the activation of the cell-specific metabolism.


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INDICATIONS

*CAUTION: Federal law restricts this device to sale by or on the order of a licensed physician or other practitioner licensed by law. See instruction manual for full warning, precaution and contraindications.

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INDICATIONSPain Management

Stimulate nerves for the purpose of providing pain relief

For adjunctive treatment of post- traumatic pain syndromes

For management and

symptomatic relief of

chronic (long-term)

INTRACTABLE PAIN As an adjunctive treatment in the

management of post- surgical problems

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INDICATIONSMuscle Stimulation

Stimulate motor nerves for the purpose of muscle rehabilitation

Relaxation of muscle spasms Prevention or retardation of disuse atrophy Increasing local blood circulation Muscle re-education Immediate post-surgical stimulation of calf muscle to prevent phlebothrombosis Maintaining or increasing range of motion

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CONTRAINDICATIONSThrombophlebitis • Manifest thrombosis • Cardiac demand pacemaker • Acute danger of hemorrhage • Disturbances in cardiac rhythm • In tetany, caution should be exercised in dosing. • Acute local inflammatory processes caused by bacterial or viral infections (for example: furuncle, phlegmon, herpes simplex, acute herpes zoster) • Do not stimulate over carotid sinus. • Do not stimulate transcerebrally! • Use adequate precautions in persons with suspected heart problems, epilepsy, or in transthoracic applications. • Use precautions following recent surgical procedures when muscle contractions may disrupt the healing process.

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Example of some ICD-9’s used by

Physicians in Pain Management

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Example of some ICD-9’s used by Physicians in Pain

Management PAIN, Low Back 724.2 PAIN, Back/ Shoulder 724.9 PAIN, Knee 719.46 PAIN, Shoulder / Joint 719.41 PAIN Atypical Facial 350.2 PAIN, Lower Extremity 729.5

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Example of some ICD-9’s used by Physicians in Pain Management Treatments

BACK PAIN

Lumbago 724.2 Other symptoms

referable to back 728.8 Edema 782.3

NeuroMed has compiled this coding information for provider’s convenience in understanding of billing. It is always the provider’s responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Provider must contact local carrier/payer for interpretation of appropriate coverage and coding policies.

NOTE: Always verify with individual insurance carrier (in your respective area) for carrier direction concerning the preferred billing codes for proper reimbursement of physical medicine treatments.

Rev: 03/13/07

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Documentation Physicians must document clearly and identify the service

rendered and why it is medically necessary for a given beneficiary for this medical device or any other product.

Physicians must document via S.O.A.P notes for a given treatment for this equipment or any other product.

Physicians must document clearly the conditions in order of importance. This equipment is used to treat PAIN (Pain Management).

Physicians must verify with individual insurance carrier’s (in his/her respective area) for the carrier’s direction concerning the preferred billing codes for proper reimbursement of Physical Treatment Medicine.

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What are the most common CPT codes used by physicianswith this medical

device?

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Physician Medicine CPT Codesused by physicians

97032- Electrical Stimulation (attended)

( each 15 min. treatment) 97014- Electrical Stimulation (un-attended) 97016- Vasopneumatic Device

97139- Unlisted Therapeutic Procedure

NeuroMed has compiled this coding information for provider’s convenience in understanding of billing. It is always the provider’s responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Provider must contact local carrier/payer for interpretation of appropriate coverage and coding policies.

NOTE: Always verify with individual insurance carrier (in your respective area) for carrier direction concerning the preferred billing codes for proper reimbursement of physical medicine treatment for this product or any other product.

Rev: 03/13/07

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Reimbursement

Average patient treatment regimen is 12-15 physical medicine treatments per I.C.D. code.

Actual reimbursement varies according to billing specialty and regional reimbursement average.

Physicians must verify with individual insurance carrier’s (in his/her respective area) for the carrier’s direction concerning the preferred billing codes for proper reimbursement of physical medicine treatment.

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Who is using this advanced technology…

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Hospitals, Universities & Medical CentersThat Have Utilized Electroanalgesic Technology

To Treat Pain

The Cleveland Clinic Foundation, Cleveland, OH Loma Linda University Medical Center, Loma Linda, CA

Charles R. Drew Univ. of Medicine &Science, LA, CA National Naval Medical Center, Bethesda, MD South Point Hospital, Warrensville Heights, OH Southeast Alabama Medical Center, Dothan, AL N. Phoenix Health Institute, Phoenix, AZ DCH Regional Medical Center, Tuscaloosa, AL Northside Hospital, Atlanta, GA Garden State Pain Control, Clifton, NJ VA Hospital Pain Clinic, Buffalo, NY Northern Oklahoma Cancer Center, Ponca City, OK Quincy Valley Hospital, Quincy, WA Portland Adventist Medical Center, Portland, ORSarasota Memorial Hospital, Sarasota, FL Saint Francis Hospital, Hartford, CTLoyola Medical Center, Forest Park, IL North Side Hospital, Atlanta, GAUSAF Medical Center, Wright Patterson, OH U.S. Naval Medical Center, San Diego, CABaylor University Medical Center, Dallas, TX LSU, Bossier, LA

And, over 2500 USA physicians are utilizing electroanalgesic treatments to treat PAIN.

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NeuroMed’s Pain Management

program

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Safe and effective, non-invasive treatment Minimal potential for side effects, easily avoided Extremely high patient compliance, outcome, and

satisfaction Substantial reduction in out-bound patient

referrals Easy to administer by existing staff members Superior source of practice revenue No capital risks No practice logistics risk. NeuroMed

handles the installation, training, billing, and collections

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How can a physician

get started?

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NeuroMed will provide the Pain Management equipment and schedule for an independent sales representative to evaluate your practice. We will also schedule your first staff training meeting and completely train your existing staff members in the field of physical medicine and electroanalgesic treatment procedures and application. Also, we train the business manager regarding reimbursement and coding issues from third-party insurers.

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Physician can start scheduling and treating pain patients in the office.

Note: Only 15 patients per day / per unit can receive treatment on a Pain Management system at 20-35 min. per treatment / per patient.

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Physician will provide superbill, patient’s insurance information, and any necessary paperwork to billing company.

NeuroMed’s billing company will handle all the billing and collections for the Pain Management treatments.

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Physicians reimbursements for Pain Management treatments that will be sent directly to physician. NeuroMed will invoice physician for training, phone support, medical device supplies, user fees, account fee, and billing / collection fees.

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The day you call

our office at

1-949-369-7135

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Is the day that you open the door to your advanced

Pain Management treatment center.

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NeuroMed Consulting, Inc.

647 Camino De Los Mares Suite 108-81

San Clemente, CA 92673 Phone:

(949) 369-7135 (949) 369-1893 FAX

Web-site address www.NeuroMedinc.com

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Opening your door to a Pain Management practice with the latest technology… Next Slide