Arizona Association of

Chiropractic
Journal
January-February- March
2015
1

Executive Committee 2013 - 2014

President
David Sheitelman
david@smedchiro.com
623-214-7600

Vice President
James Bogash, DC
info@lifecarechiro.com
480-839-2273

Immediate Past President

ReneAnn Haberl, DC
rhaberldc@gmail.com
480-941-2454

Treasurer

Secretary
Jennifer Polk, DC
dr.jenpolk@yahoo.com
480-941-1555

Executive Delegate
Kurt vonRice, DC
drbones62@earthlink.com
602-493-8700

District Delegates 2014 - 2015

Delegate
James Sieffert, DC
james@premierpainaz.com
480-205-9447

Delegate
Terese Farrar, DC
doctor@happydancing.com
623-975-4057

Delegate
Kurt vonRice, DC
drbones62@earthlink.com
602-493-8700

Delegate
Michael Stone, DC
docstone@qwest.net
520-490-9827

Delegate
Melissa Myhr, DC
m3doc@aim.com
623-878-0475

Delegate
A. Allen Gentry, DC
drgentry@gentrychiropt.com
520-745-0545

Delegate
Don Dearth
drdearth@qwestoffice.net
480-756-6044

Delegate
Joanne Siebert, DC
drjoannesiebert@gmail.com
720-206-9906
Delegate
Marc Widoff
480-688-1894

Contents:
Pg. 2: 2014-2015 Executive Committee and District Delegates
Pg. 4: Dr. Bogashs Monthly Rant
Pg. 5: Convention - Save the Date!!
Pg. 6-9: Gardisil Vaccine Protecting Children or Hurting them?
Pg. 10: Article from Don Dearth, DC
Pg. 12-13: AAC Lobbyist News
Pg. 14-15: Under-Coding; One of the Most Misunderstood Violations in the Business
Pg. 17-18: Amp Up for ICD-10 CM
Pg. 19-20: Is Your Head Where it Should Be?
Pg. 23-25: Calendar of Events
Pg. 26: Ounces Vs. Pounds
Pg. 27-28: How much is too much fish oil?
Pg. 29-30: Quick Pick Me Up Posture

BOARD COMPLAINT?
I CAN HELP!
David M. Morrison, P.C.
Attorney

Representing the Chiropractic

Profession for over 20 years!!

Call for free consultation

Phoenix: (602) 277-6996
Statewide: 1-800-446-7473
The AAC Journal is the official publication of the Arizona Association of Chiropractic, copyright 2011. All rights reserved. Articles and advertisements in the journal are subject to screening
review at the publication committee. However, the AAC does not necessarily endorse or approve advertising or statements of fact or opinion made in the Journal.

Dr. Bogashs Monthly Rant

AAC Vice President ~ Chair - Insurance Committee

Do your patients know how much you get paid?

Sure. If, they are cash paying patients; but what if they have insurance? Even then,
it's easy enough to see - they just have to check the EOB that comes from the
insurance company to see how the claim for the visit was processed.
The same should be true if that patient happens to have a high deductible plan with a HSA or
FSA. You submit your claim, the insurance company processes the claim for your fee schedule
amount and they cut you a check, taking the money to pay you from the patients' own money in his
or her HSA/FSA.
In case you're not aware, the money in a HSA/FSA is money that is put there by the patient (or in
some cases by the employer). It is essentially the patient's cash sitting in a bank account earmarked
only for qualified medical expenses.
These expenses include things like medical care, chiropractic care, dentistry, prescriptions and eyeglasses. The list is quite long, but I am pretty darn sure I have never seen a list of allowable medical
expenses that include administrative fees from the insurance companies.
Nope. Nada. Not allowed. This is because those administrative fees are already built into the premium that your patient pays for the insurance. Taking it out of an HSA/FSA would be just like paying them again. Not cool.
Incredibly, it turns out that there may be certain insurance companies here in AZ and across the US
that are double-dipping. Literally stealing from our patients' bank accounts. When I first heard this,
I thought it could not possibly be true. It would require a pretty massive set of cajones.
Here's the kick - it may be happening to your patients and neither your patient nor you are even
aware it is occurring. How? Because you don't see your patients' EOBs. You would never know if
the patient is having "extra" money being taken out of the HSA / FSA because you don't see it.
Take this as an example: You get an impressive $50 for a chiropractic visit from Mrs. Smith. The insurance company processes the claim, paying you the life-altering $50, but taking $55 out of Mrs.
Smith's HSA account. You'd never know.
It is real and it is happening. If you have a patient with an HSA/FSA with a high deductible plan,
we may need your help. Contact myself or the Association if you think you might fall into this category.
James Bogash, DC ~ Chiropractic Physician
480-839-2273 ~ LifeCare Chiropractic website ~ Dr. Bogash's Rantings blog
4

SAVE THE DATE!!!

CONVENTION IS
JUNE 5TH - 7TH, 2015!!!
2015 Location is the Care Free
Resort!!!
CA Training with Dr. Rosalind Canham, DC will
be held during convention again this year!!
Be sure to check the website often as Convention
specifics will be posted and updated
regularly!!
Specifics on speakers & courses to be announced.

Gardisil Vaccine: Protecting children or hurting them?

Timothy R. Perenich MA, DC

Dr. Perenich is 2013 graduate of National University of Health Sciences. He also has BS in psychology, a BA in theology, and an MA in religion. He currently practices in Clearwater, Florida. He can
be reached at tp161@hotmail.com.

During the 2012 Republican Primary Debates Congresswoman Michele Bachmann took Texas Governor Rick Perry to task for using an executive order to require teenage girls to take the HPV
(human paillomavirus) vaccine commonly known as Gardasil or Cervarix. In the debate Bachmann
suggested that the vaccine was harmful for girls and that it may have been responsible for the mental retardation of a young teen. Subsequently, Bachmann was attacked in the media for making outrageous claims toward a vaccine considered safe and effective. i The CDC (Centers for Disease
Control) at the time went on the defense and put out information stating that 35 million doses of
Gardasil as of June 22, 2011 had been given and only 18,727 reports of adverse events were made.
Moreover, according to the CDC, 92% of these reports were non-serious symptoms like fainting,
pain, and swelling at the injection site (the arm), headache, nausea, and fever. ii Additionally two
bioethics professors from the University of Minnesota, Steven Miles and Arthur Caplan, challenged
Bachmann even offering her money if she could provide evidence of her claims. iii Eventually the attack by the CDC, the bioethics professors, and media took its toll and Bachmann bowed out. To this
day the CDC and the professors from Minnesota maintain their position that the HPV vaccine is safe
and effective. But is this so?

Vaccines more than any other medical intervention receives the highest degree of cultural credulity.
Society is not only ingrained with the belief vaccines single handedly are responsible for saving
countless lives from dreaded diseases, but also are generally regarded as safe. Since vaccines are assumed to be safe and effective most reports of advers reactions are usually dismissed. Those that do
get reported are often such a small subsection of the actual incidence that there is no way of knowing how many serious adverse reactions are taking place. Even David Kessler former FDA commissioner admitted that only 6% of all vaccine adverse events are reported. 5 Nonetheless, the public is
continually assured by mainstream media and government outlets that the HPV vaccine is safe and
effective.

Gardisil Vaccine: Protecting children or hurting them?

Timothy R. Perenich MA, DC ~ Continued from page 6

Commenting on the safety bias as it pertains to vaccines one researcher wrote: [r]esearch into immunization has been based on the theory that the benefits of immunization far outweigh the risks
from delayed adverse events and so long term safety studies do not need to be performed. iv In
some instances this bias leads to outright falsehoods in disseminating pro-vaccination information to
physicians. In a continuing medical education (CME) course sponsored by Merck designed to increase the vaccination rates amongst children, the powerpoint material stated, under the heading
Talking to Parents About Vaccine Safety, the following talking points: 1) HPV vaccines are
among the safest (vaccines) 2 46 million doses distributed (of the HPV vaccine) in the United
States with no serious safety concerns.v Apparently the CME team at Merck designing the proHPV vaccine powerpoint was not concerned with the facts when making such statements.

The ingredients list provided by the CDC for both HPV vaccines (Gardasil and cerverix) demonstrate they each contain aluminum compounds as an adjuvant. One of these compounds, aluminum
hydroxide, has been implicated in joint pain, chronic fatigue, and cognitive decline. vi The mechanism of injury from this adjuvant is said to be caused by macrophagic myofasciitis a condition of
which occurs when macrophages consume aluminum and dump their inflammatory chemistry in
response.6 When animals are injected with aluminum hydroxide they have symptoms and histological damage which resembles diseases like Alzheimers and upper motor neuron lesions like ALS
(amylotrophic lateral sclerosis - the ice bucket challenge disease).vii
In the same vein the scientific literature reveals a number of reports associating neurological disease
and death with the HPV vaccine. While many of these reports still retain a vaccine safety bias, they
all indicate paucity of post vaccination surveillance and the need for heightened awareness of vaccine induced disease. A case study published in Neurology (2012) noted the association between neuromyelitis optica (the sometimes precursor to multiple sclerosis) in four young girls after HPV vaccination.viii While the researches clearly sided in favor of pro-vaccine bias they admitted such findings
were troubling because the information pertaining to post vaccination surveillance is limited. Thus,
they have no way of knowing the true incidence and severity of neuromyelitis optica amongst the
vaccinated and neither do they know the long-term effects of the HPV vaccine.

Gardisil Vaccine: Protecting children or hurting them?

Timothy R. Perenich MA, DC ~ Continued from page 7

Another case published by Tomljenovic and Shaw investigating the histopathology of two teenage
females 19 and 14 years of age who died after getting their HPV shots. They found, after laboriously
looking at the brain tissue of the girls who died, evidence of vaccine induced cerebral vasculitis. ix
They concluded that specific antigens in the vaccine most likely caused a fatal autoimmune reaction
in these young women. The death of two teenage girls for the supposed benefit of cervical cancer
protection is hardly scientific, logical or even a noble sacrifice for the greater good.

If autoimmune disease and death are not bad enough the BMJ published a case report of a 16 year
old girl who suffered from ovarian failure after HPV vaccination. x Disturbingly, researches examining the case were unable to get histological data from rat ovaries from which the HPV vaccine was
originally tested, even after filing a freedom of information act request. Worse of all they admit that
a number of variables make it difficult for them to assess just how many girls may lose or lost the
ability to have children due to this vaccine. How could a vaccine like this be worth the risk of never
having children versus the small risk of cervical cancer? It is interesting to point out that if any alternative therapy (chiropractic, acupuncture, herbal medicine, or hydrotherapy) was associated with
just a handful of cases of neuromyelitis optica, MS, death and female infertility it would be banned
from the USA and its practitioners would be jailed or fined out of existence.

On June 14, 2013, after looking at the evidence in favor of the HPV vaccine and reports of adverse
reactions following it, the pro-vaccine government of Japan decided not to recommend this vaccine
for its young girls. Despite all these facts pro-vaccine proponents will continue to parrot the mantra
that vaccines are safe and effective.

In addition to the serious adverse events caused by the vaccine, evidence suggests it may not be effective in preventing cervical cancer. Dr. Diane Harper MD a principal investigator in the HPV vaccine trials sponsored by GSK and MERCK has argued that regular pap screening for women at the
age of 21 for life is more effective to prevent cervical cancer than the HPV vaccine. xi Additionally she
pointed out rates of cervical cancer in the United States are nearly as high as rates of adverse reactions to the HPV vaccine in those who received it. 11 Moreover, the vaccine itself does not have lasting protection so giving the shots to young non-sexually active girls is futile. Studies demonstrate
that any protective value of the vaccine lasts maybe five years. 11 ~ Continued on page 9
8

Gardisil Vaccine: Protecting children or hurting them?

Timothy R. Perenich MA, DC ~ Continued from page 8

And, the vaccine does not protect from all the various HPV viruses which can cause cancer. However, Harper, is probably most emphatic, with her criticism toward the vaccine when she points out
95% of all HPV infections are cleared spontaneously by the bodys immune system. The remaining
5% progress to cancer precursorsGardasil is not really a cervical cancer vaccine. The vaccine prevents HPV infection not the development of cervical cancer. 11
With Harper being such a credible expert on both HPV and the HPV vaccine, one has to wonder
why the public did not hear more from her? Why arent doctors who give vaccines made aware of
her cogent analysis and expert opinion? Perhaps it is because the pharmaceutical industry and governmental regulatory agencies have a vested interest in saving face. For they know if they public
was aware of such things billions of dollars would be lost from unused vaccines due to a decline in
public trust in vaccination.
Nevertheless, the media and supposed academic experts who gave Michele Bachmann an unmitigated drumming for her comments concerning the Gardasil have never retracted their statements
despite the mounting evidence in opposition to the safe and effective mantra. Though politicians get their facts wrong occasionally and make off-the-cuff statements, apparently so does the
media and academics who attempt to shield themselves with the banner of science while making
unsubstantiated claims in favor of vaccine safety and efficacy. Thus no matter what one decides for
their daughter and now also their son, regarding the HPV vaccine, they should do their research instead of trusting politicians and mainstream media outlets.

Weiner R. Bachmann claims HPV vaccine might cause mental retardation. The Washington Post.
9/13/2011 (Found at http://www.washingtonpost.com/blogs/the-fix/post/michele-bachmann-continues-perry-attack-claims-hpv-vaccine-might-causemental-retardation/2011/09/13/gIQAbJBcPK_blog.html)
ii Amira D. Debunking Michele Bachmanns HPV Anecdote. New York Magazine. September 13, 2011 (http://nymag.com/daily/intelligencer/2011/09/
gardasil_hpv_vaccine_bachmann_perry.html)
iii Perry S. Bioethicists Miles and Caplan Challenge Bachmanns HPV-vaccine claim. MinnPOST. September 15, 2011 (http://www.minnpost.com/
second-opinion/2011/09/bioethicists-miles-and-caplan-challenge-bachmanns-hpv-vaccine-claim) [http://www.cdc.gov/vaccinesafety/Vaccines/HPV/
Index.html]
iv Clausen JB. Letter: Public should be told that vaccines may have long term adverse effects. BMJ. 1999; 318:190-6.
v Schaffner W. Adolescent Immunizations: A Back-to-School Checklist. Medscape CME Accessed 7/14/2012.
vi Couette M, et al. Long-term persistence of vaccine-derived aluminum hydroxide is associated with chronic cognitive dysfunction. Journal of Inorganic Biochemistry. 2009; 103:1571 - 1578.
vii Shaw CA, Petrik MS. Aluminum Hydroxide injections lead to motor deficits and motor neuron degeneration. Journal of Inorganic Biochemistry.
November 2009; 103(11):1555.
viii Menge T, Cree B, Saleh A, Waterboer, Berthele A, Kalluri SR, et al. Neuromyelitis optica following human papillomavirus vaccination. Neurology.
July 17, 2012; 79
ix Tomljenovic L, Shaw CA. Death after Quadrivalent Human Papillomavirus (HPV) Vaccination: Causal or Coincidental. Pharmaceut Reg Affairs.
2012;S12:001
x Little DT, Ward HRG. Premature ovarian failure 3 years after menarche in a 16-year-old girl following human papillomavirus vaccination. BMJ Case
Reports. 2012; doi:10.1136/bcr-2012-006879
xi Yerman MG. An Interview with Dr. Diane M. Harper, HPV Expert. Huffpost: Healthy Living. March 18, 2010 (Accessed at http://
www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian-b405472.html).
i

Article provided courtesy of Donald H. Dearth, DC

For the past 27 months the Arizona Industrial Commission Director's Advisory Committee
on Evidence Based Medicine (EBM) has been meeting at the Industrial Commission near the
Capital for the purpose of examining various guidelines for the care of injured workers in
Arizona. There were stakeholders in attendance representing insurers, claim reviewers,
various provider groups and attorneys representing injured workers. The primary goal of
all involved was to provide the best care possible for injured workers. Reviewing overall
costs of care led the group to consider the major areas of significant cost over time that
would benefit from the use of a Nationally recognized practice guidelines involving only
chronic care and Opioid use. Although most specialty provider groups have some type of
guidelines or consensus documents addressing treatment protocols, the group wanted to use
a Nationally recognized guideline and the ODG guidelines were adopted and recommended to the Industrial Commission Board. The committee felt that guidelines should be
used to provide support in the two mentioned areas only and not all care as Arizona injured
workers care and costs are generally reasonable when compared to other states. Even with
the committees recommendation of the ODG guidelines for the treatment of Chronic care
and the use of Opioids, attorneys and provider groups are asking to allow a profession specific guideline to carry weight in consideration if the ODG guidelines differ from a profession specific guideline such as the CCGPP guidelines for Chiropractic care. The EBM committee reviewed the four major recognized guideline documents over several months and
applied practical scenarios of applied care to several real cases. An ad hoc committee on
chronic pain was formed which included DC, DO, MD, and PT representatives to advise the
committee on treatment specifics. I want to thank AAC Health Services and Insurance Committee Chairman James Bogash, DC for helping to advise the EBM committee in the tasks involved. One future concern would be the adoption of ODG guidelines for all care provided
regarding injured Arizona workers. Most providers general utilization in most areas show
little need for additional hurdles to care or authorization. Most care is within the "bell
curve" and the committee saw no need for additional focused implementation control. It
was an honor to represent the Chiropractic profession and protect our access to injured
workers while seeing how other professions can learn to cooperate with us. We have much
to do to increase those relationships with workers for them to see the advantage of our care
for most neuromuscluoskeletal injuries.
Donald H. Dearth, DC

10

11

AAC Lobbyist News

Barry M. Aarons - AAC Lobbyist

There will be some new and some not so new in Arizona State Government when the
Legislature convenes on January 12th. The personality of the Arizona House and Senate is
pretty much the same as it has been during the past two years. Yes we have a new Governor
in outgoing State Treasurer and businessman Republican Doug Ducey and a new Speaker in
Cochise County Republican David Gowen. But we also have returning Republican Senate
President Andy Biggs and the Republican majorities remain the same with a 36 to 24 count
in the House and a 17 to 13 count in the Senate.
So just what can we expect from during the 2015 Regular Session? First and foremost
are the states budget woes. The Arizona economic recovery from the Great Recession has
been weaker than has been enjoyed in most of the rest of the country. Revenue during the
last six or so months of calendar 2014 have been well below what had been expected when
the current fiscal 2015 budget was adopted in April Barring an unforeseen and most likely
unexpected economic boost the budget will start at perhaps $200 million or more in the red.
Add to that a recent court decision that declared that some of the recessionary cuts in
K-12 education were unconstitutional. That decision will require that the Legislature - beginning in the current fiscal 2014 budget - increase school spending funding to the tune of over
$300 million. The Governor and Legislature faces the daunting task, therefore, of having to
tackle a one half billion dollar deficit - a hole that has to be plugged as soon as they take office.
For the Chiropractic community that means that any proposals that are perceived to
add additional costs to state government will likely not have a warm reception. It also means
that existing agency funds could be in jeopardy. Already we are hearing some legislators
suggest that sweeps are inevitable. So for regulatory agencies, like the Board of Chiropractic
examiners any unexpended funds that are expected to remain unused by the June 30th end
of fiscal year could be swept into the general fund to help plug that previous mentioned
hole.
It is important to remember that the board operates on funds collected as licensing
fees by chiropractors. While no one wants to pay fees the fact is that the chiropractic community wants fair competent regulation and understands that those fees that they pay will go to
that level of oversight. But when those funds are swept then the licensing fees become de
facto professional service taxes. That is something that makes us very uncomfortable.
12

AAC Lobbyist News

Barry M. Aarons - AAC Lobbyist

Which brings us to the legislation that the Board will be proposing when the session commences. The focus of that bill is to allow on new fees with modest increases henceforth to be set
by Board rule. In and of itself this is not an unreasonable request. The Board has in fact been
hamstrung by a lack of funds for the past several years. But if this increase in fees comes on the
heels of fund sweeps then we may have to rethink how benign those increases actually are.
Also of interest in the coming session could be renewed consideration to allow AHCCCS
patients to be covered for chiropractic care. Remember that at the end of last session that proposal was in the original Senate passed budget but failed to survive the final enactment when
the House added emergency dental, podiatry, and other services.
We did not coordinate with other health care professionals also seeking AHCCCS coverage last session. Other than the AAC proposed SB 1044 which would have provided AHCCCS
patients with chiropractic coverage no other bill on this subject was even introduced. This year
we are starting as a united group with a commitment to throw no one overboard as we pursue a joint effort to get chiropractic, podiatry, emergency dental and orthotics added to permissible AHCCCS coverage.
Generally the legislature perceives that this will add an initial cost, as existing capitation
rates do not include these services. But the fact remains that if AHCCCS administrators were
willing to adjust capitation rates there likely would be no additional cost to its enactment.
Other issues of importance to the chiropractic community are likely to come up in the legislative session and we will be advising you of those and what the AAC is doing to protect chiropractic as 2015 unfolds.

13

Under-Coding; One of the Most Misunderstood Violations in the Business

~Dr. Ray Foxworthy, D.C.~

As both a chiropractor and a Medical Compliance Specialist-Physician (MCS-P), Im out

there in the trenches talking to DCs all over the country. And Im dismayed at how many
doctors still think that that all they have to do to charge a lower fee for cash or underinsured
patients is tweak their coding (all while continuing to charge higher codes for Medicare,
third-party payers and Workmens Comp).

Theres an important conversation we need to be having as a profession about under-coding,

and it begins with the fact that it is every bit as much of a risk as over-coding. In fact, it can
be considered inducement, a kick-back, maintaining a dual fee schedule, and abuse. It all
adds up to that dreaded five-letter word: AUDIT.

Keep in mind, the OIG doesnt care why the doctor took action. So if a DC, no matter how
lovingly and kindly, tries to help out a cash or underinsured patient by coding for a lesser
service or fewer services than were actually performed and charges accordingly, theyre in
hot water, no matter how nice they may have been trying to be.

Theres a safe way to offer discounts to help out patients and there are an almost infinite
number of illegal ways to do so. Among the latter, under-coding is possibly the most tricky,
because doctors think that by under- instead of over-coding, theyre flying under OIG radar.

Nothing could be further than the truth. Under-coding, is, quite simply, fraud. It represents
discriminatory billing, which carries not only the taint of a dual fee scheduleone for cash
patients, the other for Medicare and third-party payersbut also can be viewed as a kickback or inducement. After all, Medicare defines inducement as offering any free or reduced
service to a patient to encourage providing a service that would be covered by Medicare.

14

Continued: Under-Coding; One of the Most Misunderstood Violations in the Business

~ Dr. Ray Foxworthy, D.C. ~

Under-coding can also be considered abuse as defined by the Centers for Medicare & Medicaid Services (CMS): misusing codes on a claim. Since under-coding almost always takes the form of
overreliance upon the same lower value codes, the flag that pattern raises isnt just red, but flashing
like a stoplight: if your coding shows the same low value codes showing up over and over again,
you might as well be wearing a sign that says, Please audit me!
Happily, no doctor need resort to under-coding to make their care more affordable to uninsured,
underinsured or partially insured patients. Thats why I started ChiroHealthUSA, a Discount Medical Provider Organization (DMPO) that allows participating doctors to set legal discounts of their
choosing for member patients. Theres no cost to the doctor, and a mere $39 per year per family
charge to the patient.
Every Tuesday, we give a free webinar explaining the benefits of joining ChiroHealthUSA. You can
register at www.chirohealthusa.com.
Dr. Ray Foxworth is a certified Medical Compliance Spe-cialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains in the trenches facing challenges with billing, coding, documentation and compliance. He has served as president of the Mis-sissippi Chiropractic Association, former Staff Chiro-practor at
the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic.
You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visit the ChiroHealthUSA
website at www.chirohealthusa.com. Join us for a free webinar that will give you all the details about how a
DMPO can help you practice with more peace of mind. Go to www.chirohealthusa.com to register today.

15

16

AMP UP for ICD-10-CM

~ Angela Powell - CPC - CCO ~ Continued on page 18
Deadline for ICD-10 is set for October 15, 2015.
On July 31, HHS issued a rule finalizing October 1, 2015 as the new compliance date for health care
providers, health plans, and health care clearinghouses to transition to ICD-10. This deadline allows
providers, insurance companies, and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015. The ICD-10
codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and
private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patients care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to
greater accuracy of reimbursement for medical services. The code sets granularity will improve
data capture and analytics of public health surveillance and reporting, national quality reporting,
research and data analysis, and provide detailed data to enhance health care delivery. Health care
providers and specialty groups in the United States provided extensive input into the development
of ICD-19, which includes more detailed codes for the conditions they treat and reflects advances in
medicine and medical technology.

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patients health than with ICD-9-CM. Moreover, the level of detail that is
provided for by ICD-10 means researchers and public health officials can better track diseases and
health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying
causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology, and preventative services.
ICD-10 represents a significant change that impacts the entire health care community. As such,
much of the industry has already invested resources toward the implementation of ICD-10. CMS has
implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, have completed the necessary system changes to
transition to ICD-10, the time offered by Congress and this rule will allow others to take advantage
of the training offered to ensure all providers are ready.
17

AMP UP for ICD-10-CM

~ Angela Powell - CPC - CCO ~
ICD-10 Testing Opportunities for Medicare FFS Providers
On July 31, HHS issued a rule (CMS-0043-F) finalizing October 1, 2015 as the new compliance date
for health care providers and health plans to transition to ICD-10. ICD-10 represents a significant
code set change that affects the entire health care community.
CMS is taking a comprehensive four-pronged approach to preparedness and testing for ICD-10 to
ensure that CMS, as well as the Medicare Fee-For-Service (FFS) provider community, is ready:
CMS internal testing of its claims processing systems
CMS Beta testing tools available for download
Acknowledgement testing
End-to-end testing
Acknowledgement Testing
This past March, CMS conducted a successful ICD-10 acknowledgement testing week. Providers,
suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test
claims anytime up to the October 1, 2015 implementation date. In addition, special acknowledgement testing weeks in November, March, and June of 2015 will give submitters access to real-time
help desk support and allows CMS to analyze testing data. Registration is not required for these virtual events. Contact your Medicare Administrative Contractor (MAC) for more information about
acknowledgment testing.
End-to-End Testing
CMS plans to offer providers and other Medicare submitters the opportunity to participate in end-to
-end testing with MACs and the Common Electronic Data Interchange (CEDI) contractor in January,
April, and July of 2015. As planned, approximately 2,550 volunteer submitters will have the opportunity to participate over the course of three testing periods. The goals of this testing are to demonstrate that:
Providers and submitters are able to successfully submit claims containing ICD-10 codes to the
Medicare FFS claims systems
CMS software changes made to support ICD-10 result in appropriately adjudicated claims
Accurate Remittance Advices are produced
Check the ICD-10 Medicare FFS Provider Resources web page for the latest information and educational resources to implement and transition to ICD-10 medical coding.

18

IS YOUR HEAD WHERE IT SHOULD BE?

~ Steven Weiniger, DC ~
You almost certainly have this posture problem. Heres how to fix it
Are you part of the poor posture epidemic? Its estimated that two out of every three American
adults now have forward head posture (FHP), an increasingly common condition in which the head
juts out past the shoulders, placing excessive stress on the neck and back.
FHP can be caused by such simple things as texting, driving or even the type of glasses you wear,
but it can trigger a surprisingly wide variety of troubling health conditions - from neck, back and
shoulder painto headaches, digestive issues, breathing difficulties and even arthritis. Good news:
FHP can often be corrected with simple exercises and lifestyle changes.
WHAT CAUSES FHP
A main culprit of FHP is frequent computer use - people tend to lean forward in an effort to see their
computer screens. Texting is another common cause, as most people hunch over their smart phones.
Other triggers include: Bucket seats in cars - they encourages an unnatural bend in the
bodyreading or watching TV while on an exercise machine at the gym - straining to see the page
or screen forces the head out of alignmentbifocals - these glasses force you to tilt your head backward and stick your chin out in order to see through the lower portion of the lensescarrying a
heavy backpack - the load causes your head to protrude forward and the natural process of aging as the neck muscles weaken, the head drifts forward.
Startling Fact: Every inch that your head moves forward past your spine, adds 10 pounds of
pressure to the neck and back, which often leads to muscle and joint pain and headaches. A forwardhanging head also compresses the rib cage, compromising the lungs ability to expand by as much
as 30% and slowing down digestion. Whats more, over time, FHP can cause the spine to stiffen, limiting range of motion and contributing to osteoarthritis.
Recent Study: When more than 800 adults over age 65 were followed for about five years,
those who began leaning forward at an earlier age were 3.5 times more likely to require assistance
bathing, dressing, eating and getting in and out of chairs than those who started leaning forward
later.
EASY TO SELF-DIAGNOSE
A simple photo is often all you need to determine whether you have FHP. Put on some gym clothes
and stand as you normally would in a straight but not stiff position. Then have a spouse or friend
snap a full-length photo of you from the side. Look at the photo the middle of your ear should be
lined up with your shoulder, hipbone and ankle. If your head is forward the alignment of your body
is off. Save the photo as a baseline, and have a photo taken monthly to monitor your progress once
you begin using the strategies below.

19

IS YOUR HEAD WHERE IT SHOULD BE?

~Steven Weiniger, DC~ Continued from page 19
HOW TO HELP YOURSELF
Become more aware of your head position. Lying down on the floor, flat on your back, take a
moment to notice where your gaze naturally falls - if you have FHP, you will likely be looking slightly back and away from your feet (those who have healthy posture will be looking
straight up at the ceiling).
To recognize the proper head position: While still lying on your back, gently lift your
head just off the floor and tuck in your chin to give yourself a slight double chin. Then keeping your chin tucked, put your head back down. If youre looking straight up at the ceiling,
your head is now in the proper level-head position.
Take five slow breaths here; then relax on the floor for two to three minutes to let your
head align with your torso and pelvis. Do this two to three times a day to help retrain your
body. If you have discomfort in your low back, put a small pillow under your knees.
Perform chin tucks every day. Initially, do these exercises on the floor. Lying down in the levelhead position, take a deep breath inwhile exhaling; press your chin into a tuck. Release and
repeat for five cycles, two to three times a day.
If the stretch in the back of your neck feels too intense or you cant keep your head
level, try propping your head up on an inch-thick book wrapped in a thin towel. (Use a book
you dont want, since youre going to be removing pages.) After doing this exercise a few
times a day for three or four days, remove about an eighth of the pages. Repeat for a few
more days and remove another small section of pages, continuing this cycle until the book is
empty and your head is flat on the ground.
As chin tucks become easier, you dont have to do them lying down and can do them
regularly throughout the day - at your computer or even walking down the street.
Make other changes to your daily routine. The average American logs about 11 hours of screen
time per day - including time spent on computers, using smart phones and watching TV. At
work and at home, make sure your computer screen is at eye level. If you use a laptop, use a
laptop stand and purchase a separate keyboard. When using a smart phone for texting or
email, try to hold it at eye level. When wearing bifocals for reading, adjust the glasses on your
nose rather than changing your head position. These strategies will help keep your ears in
line with your shoulders and may even help prevent wrinkles caused by squinting.
And before driving, be sure the seat is not tilted excessively backward - this forces you
to hold your head at an angle that contributes to FHP.
Use a cervical pillow for sleeping. Cervical pillows improve spinal alignment by cradling the
head and supporting the neck, usually with an indentation or cutout in the middle of the pillow. You may need to try several pillows before finding the one thats most comfortable for
you. I like the cervical pillows by Therapeutica (TherapeuticaInc.com) and Tempur-Pedic
(TempurPedic.com) and the Chiroflow Water Pillow (Chiroflow.com).
If after two to four weeks of trying these strategies youre still experiencing health
problems related to FHP, be sure to see a chiropractor or physical therapist.
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Events for February 2015

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Ounces Vs. Pounds

~ Dr. Ray Foxworthy ~
Ounces vs. Pounds
Someone once said that an ounce of prevention is worth a pound of cure. That someone, however, didnt figure
on Medicare. Your Medicare patientsas well as many of your other third-party payer patientsonly have chiropractic coverage for activenot preventive, not maintenancecare. I dont know about you, but as a secondgeneration chiropractor, giving nothing but those countless pounds of cure that I know might have been avoided
with an ounce of preventive care is beyond frustrating.
Its frustratingand confusingfor patients as well. Taking Medicare as the simplest and most common example,
your Medicare patients are only covered for an episode of care: one that has a clear beginningfrom that first
presentation with chief complaint, a middleyour diagnosis and treatment plan with the requisite functional
goalsand an end: the point at which you determine the original issue is resolved, assuming it can be resolved, or
has reached maximum clinical improvement and the patient is dismissed from active care.
Annnnd thats all, folks.
But wait, patients and DCs alike say. What happens now? I want to make sure this injury doesnt happen again. I
want holistic, preventive and wellness care!
And you can absolutely offer it. You just cant get Medicare or most third-party payers to reimburse for it. This is
something that the patient must pay for themselves.
For many patients, thats a financial hurdle too high to overcome. No matter how invested they may be in their
own well-being, no matter how good a job youve done on educating them about the importance of spinal health,
without insurance coverage, theyre simply not in a position to pay for the wellness care they want and deserve.
I think thats completely outrageous. And thats why I founded ChiroHealthUSA. ChiroHealthUSA is a Discount
Medical Plan Organization (DMPO) that allows DCs to offer legal discounts to their underinsured, uninsured or
partially insured patientsand the discount is of the doctors choosing. Theres no cost to the doctor to become
a ChiroHealthUSA provider, and significant savings available for patients. For just $49 per family per year, patients
enjoy substantially reduced fees on everything from that comprehensive initial visit to, yes, maintenance care.
To find out more about how ChiroHealthUSA can give you back the patient-centered practice you wanted when
you graduated from chiropractic college and help your patients receive affordable preventive care, register for
one of our free weekly webinars at www.chirohealthusa.com. What you learn can help your patients, and your
community get healthier while improving your Patient Visit Average (PVA) and your bottom line. Win-win!
Dr. Ray Foxworth is a certified Medical Compliance Spe-cialist and President of ChiroHealthUSA. A practicing Chiropractor,
he remains in the trenches facing challenges with billing, coding, documentation and compliance. He has served as president of the Mis-sissippi Chiropractic Association, former Staff Chiro-practor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990,
info@chirohealthusa.com or visit the ChiroHealthUSA website at www.chirohealthusa.com. Join us for a free webinar
that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to
www.chirohealthusa.com to register today.

26

How much is too much fish oil?

~ Dr. David R. Seaman, DC, MS ~
We humans have a tendency to take things to the extreme. We over-eat, over-work, over-party, over-play,
and now we even over-Facebook. And then when it is time for people to go the other way move towards
health, they over-exercise, calorie obsess, and over-analyze whatever they eat.
Regarding food consumption, I remain impressed by how little thought goes into over-eating proinflammatory food calories from sugar, flour, trans-fats, and omega-6 fatty acids; however, when it comes to
eating properly, people start to worry about what is good for them. Why would we worry so much about
what is good, when we had absolutely no worry about what was bad when we were recklessly eating everything in sight? We humans are a weird bunch.
When it comes to fish oil supplementation, our weirdness continues. If a little fish oil is good, gallons must be
better, correct? The answer is probably not in most cases.
If we look at traditional diets, the largest source of fat calories came from saturated and monounsaturated
fatty acids, which contain no or one double bond respectively. The a very small percentage came from polyunsaturated fatty acids, which contain two or more double bonds. The greater the number of double bonds
in a fatty acid, the greater the chance for a fatty acid to oxidize. Interestingly, the body only needs a small
amount of polyunsaturated fatty acids and nature happens to provide us with food that only contains small
amounts.
EPA and DHA are the omega-3 fatty acids we supplement with in form of fish oil. We can make EPA and
DHA from alpha-linolenic acid, which is found in small amounts in green vegetables and certain seeds, such as
hemps, chia, and flax. EPA and DHA are also found preformed in wild animals and fish that eat vegetation. It
turns out that EPA and DHA have the most double bonds found in nature.
The fact that we do not get a lot of linolenic acid in most foods, would lead to the assumption that we might
not need a lot of EPA and DHA. In fact we do not get appreciable amounts of EPA and DHA from animals,
save for certain fish, such as salmon. Historically salmon and other wild fish was consumed by native people
who ate no sugar, flour, trans fats and no omega-6 oils such as corn, safflower, sunflower, cottonseed or peanut oils. These same people were very active; we are not.
We should follow the historical lead of native people and stay active and avoid sugar, flour, trans fats, and
excess omega-6 oils. We should eat only/mostly natural foods. And the best evidence suggests that taking 1-3
grams of EPA/DHA per day is reasonable, which is what I personally do.
I am not in the habit of taking 5, 10 or more grams of EPA/DHA. This would have been humanly impossible
in past history. However, at times, it might be useful to take heavy doses of EPA/DHA for short periods. A
recent example of this was very high dose EPA/DHA supplementation in 8-24 year olds suffering from major
depressive disorder who were not responding to their selective serotonin reuptake inhibitor (SSRI) (1). The
average participant age was 15.6 years. Twelve subjects were in the low dose group that took 2.4 grams of
EPA/DHA. Eight subjects in the high dose group took 16.2 grams of EPA/DHA. The study period was 10
weeks of supplementation wherein the SSRIs were also taken.

27

How much is too much fish oil?

~ Dr. David R. Seaman, DC, MS ~ Continued from page 27
The reason the authors took on this study is because previous studies have shown that depressed individuals
have reduced red blood cell levels of EPA and DHA. The subjects in this study also had lower levels of EPA/
DHA compared to age-matched controls. At the end of the 10-week trial, EPA/DHA levels normalized and
symptom remission was observed in 40% of the low dose group and 100% in the high dose group. This was
an open-labeled pilot study with only 20 subjects and so the authors indicate that larger blinded placebocontrolled trials are necessary.
In my opinion, the best natural approach for dealing with depression is to dramatically change the diet so that
pro-inflammatory foods are avoided in favor of anti-inflammatory foods. The reason is that we now know
that depression is a chronic inflammatory state (2-8). The metabolic syndrome, a pro-inflammatory state, has
also been shown to promote depression (9-11). And finally, compared to an anti-inflammatory diet rich in
fish, vegetables and fruit, a pro-inflammatory diet heavily loaded with sweetened desserts, deep fried food,
processed meat, and refined grains has been shown to promote depression in middle-aged individuals (12).
The chronic inflammatory state in depression and in general, involves more than just an imbalance of EPA/
DHA that requires heavy omega-3 dosing. In addition to eating an anti-inflammatory diet, supplementation
with a multivitamin (13), magnesium (14), omega-3 fatty acids (15), and vitamin D (16) also offer benefits, as
does regular exercise (17).
References
1.
McNamara RK et al. Detection and treatment of long-chain omega-3 fatty acid deficiency in adolescents with SSRI-resistant major depressive disorder. PharmaNutrition. 2014;2:38-46.
2.
Wium-Andersen MK, Orsted DD, Nielsen SF, Nordestgaard BG: Elevated C-reactive protein levels, psychological distress, and depression in 73,131 individuals. JAMA Psychiatry 2013, 70:176184.
3.
Khairova RA, Machado-Vieira R, Du J, Manji HK: A potential role for pro- inflammatory cytokines in regulating synaptic plasticity in major depressive disorder. Int J Neuropsychopharmacol 2009, 12:561578.
4.
Miller AH, Maletic V, Raison CL: Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol
Psychiatry 2009, 65:732741.
5.
Krishnadas R, Cavanagh J: Depression: an inflammatory illness? J Neurol Neurosurg Psychiatry 2012, 83:495502.
6.
Irwin MR: Inflammation at the intersection of behavior and somatic symptoms. Psychiatr Clin N Am 2011, 34:605620.
7.
Bonaccorso S, Meltzer HY, Maes M: Psychological and behavioral effects of interferons. Curr Opin Psychiatry 2000, 13:673677.
8.
Dantzer R, OConnor JC, Freund GG, Johnson RW, Kelley KW: From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008, 9:4656.
9.
Heiskanen TH, Niskanen LK, Hintikka JJ, Koivumaa-Honkanen HT, Honkalampi KM, Haatainen KM, Viinamaki HT: Metabolic syndrome
and depression: a cross-sectional analysis. J Clin Psychiatry 2006, 67:14221427.
10.
Koponen H, Jokelainen J, Keinanen-Kiukaanniemi S, Kumpusalo E, Vanhala M: Metabolic syndrome predisposes to depressive symptoms:
a population-based 7-year follow-up study. J Clin Psychiatry 2008, 69:178182.
11.
Miettola J, Niskanen LK, Viinamaki H, Kumpusalo E: Metabolic syndrome is associated with self-perceived depression. Scand J Prim
Health Care 2008, 26:203210.
12.
Akbaraly TN et al. Dietary pattern and depressive symptoms in middle age. Brit J Psychiatry. 2009;195:408-13.
13.
Suarez EC. Plasma interleukin-6 is associated with psychological coronary risk factors: Moderation by use of multivitamin supplement.
Brain, Behav, Immunity. 2003;17:296303.
14.
Eby GA, Eby KL. Magnesium for treatment-resistant depression: a review and hypothesis. Med Hypoth. 2010;74:649-60.
15. Kiecolt-Glaser JK et al. Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults. Psychosomatic Med. 2007;69
(3):217-24.
16.
Vieth R, Kmball S, Hu A, Walfish PG. Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000
IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal 2004, 3:8.
15. 17. Blumenthal JA et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69(7):587-96.

Bio ~ Dr. David R. Seaman, DC, MS ~

David R. Seaman, DC, MS, is a professor of clinical sciences at the National University of Health Sciences in Pinellas
Park, Florida, where he teaches clinical nutrition and evaluation and management of the musculoskeletal and cardiorespiratory systems. Dr. Seaman has authored a book on clinical nutrition for pain and inflammation and has written several chapters and articles on this topic. He is a consultant for Anabolic Laboratories and is on the Speakers Bureau for
NCMIC.
28

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