Disclosure. Co-Author of The 5 Minute Osteopathic Manipulative Medicine Consult
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1 Disclosure Co-Author of The 5 Minute Osteopathic Manipulative Medicine Consult
2 Top 10 OMM Techniques for the Ambulatory Setting Millicent King Channell, DO, MA, FAAO Associate Professor Chair, Dept of OMM ROWAN-SOM
3 What are the Reasons Preceptors Say for not DOing OMT? I don t want HVLA done on my patients My preceptors didn t let me do OMT because they didn t do it I don t know what to do or when to do it True No time to do OMT False You can t bill for OMT False There s no evidence to support OMT False
4 Let s D.O. the Numbers 29 DO-granting medical schools; these schools educate students at 37 locations in 28 states. 78,000 osteopathic physicians 23,144 osteopathic medical students 22% of all US medical students 20facts% pdf
5 Defining Your Realistic OMT Goals Define the system that is most prevalent for the specific rotation ex Surgery= GI Review 3 components most relevant to the diseases of the rotation ex OB/Gyn Musculoskeletal (Psoas, Obterator internus,levator Ani etc) Autonomic (Pelvic Sphlanchnics, T12-L2) Lymphatic (Common iliac nodes- para-aortic nodes) Identify 2 or 3 techniques to focus on for every 4 weeks of the rotation ex Pulm rib raising, cervical FPR pedal pump
6 10 Techniques for Most Occasions OA release Lymphatic techniques of the head Cervical Counterstrain Seated Thoracic Muscle Energy/HVLA Direct Inhibition for Trapezius Rib Raising Psoas Counterstrain Piriformis Muscle Energy Supine Sacral Gapping Muscle Energy Innominate Dysfunction
7 Have a Crutch: Pocket Manuals and Apps ACOFP OMT iphone Application
8 Pocket Manual to OMT
9 5 Minute Osteopathic Manipulative Medicine Consult
10 ACOFP OMT iphone App
11 So How Do You Document and Bill? Know the Why and the What
12 ICD9 Codes ICD-9 Codes 9=Why Descriptors Head (Occipito-cervical) Cervical (Cervical-thoracic) Thoracic (Thoraco-lumbar ) Lumbar (Lumbo-sacral) Sacrum Pelvis (Hip Region) Lower Extremities Upper Extremities (Acromioclavicular and sternoclavicular regions) Rib Cage Abdomen/Other/Viscerosomatic International Classification of Diseases 9 th Edition, Vol 1 p
13 Evaluation & Management Codes = What EM Code Number of Regions Treated Body Regions Body Regions Body Regions Body Regions Body Regions Current Procedural Terminology Gordy, K. Ed; American Medical Association, Chicago. P 450, 1999
14 Case Example 33 year old male presents with nasal congestion and green rhinorrhea for 1 week. The patient has a post nasal drip and morning non productive cough. The patient denies fevers, chills, NVD or HA. He has not tried any over the counter medications or other treatments. He denies sick contacts
15 How Do You Document? Without OMM HEENT- NCAT, PERR, Clear canals, NL TM B/L, Nasal passages boggy with green rhinorrhea, post nasal drip in pharynx Lymphatics- No Adenopathy CV- RR, no murmurs, no ectopy Lungs- CTA B/L With OMM HEENT- NCAT, PERR, Clear canals, NL TM B/L, Nasal passages with green rhinorrhea, post nasal drip in pharynx Lymphatics- No Adenopathy CV- RR, no murmurs, no ectopy Lungs- CTA B/L Biomechanical Exam- Head- OA FSRRL, tenderness over maxillary sinuses with bogginess of facial soft tissue Cervical- C2 RSR, C4-5 RSL Thoracic- T4-7 RRSL
16 How Do You Document Assessment and Plan? Without OMM 1) Bacterial Sinusitis amoxicillin/clavulanate 875 mg twice daily for days With OMM 1) Bacterial Sinusitis amoxicillin/clavulanate 875 mg twice daily for days 2) SD of Head- OCF (CR), pt tolerated well 3) SD of the Cervical- HVLA, pt tolerated well 4) SD of the Thoracic- ME, pt tolerated well
17 How Do You Bill? Without OMM 1) Bacterial Sinusitis With OMM 1) Bacterial Sinusitis ) Somatic Dysfunction of Head ) Somatic Dysfunction of the Cervical ) Somatic Dysfunction of the Thoracics 739.2
18 Summary Get your crutches out Create a short list of techniques for your specialty Practice them all rotation long Be integrative and repetitive, not exclusive
19 To the Tables!!!
20 Thank You
on Rotations Millicent King Channell, DO, MA Associate Professor Dept of OMM
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