helping you find a more cost effective treatment … next slide

Helping you find a more cost effective treatment …

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for your injured employees or

your company.

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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.

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Rev: 08-25-07

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 manufacturer’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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About us

Understanding Workers’ Compensation expenditures…

Is this new Technology?

The history…

What is an Electroanalgesia ?

The theory…

What are the most common CPT codes

Some ICD-9 codes used by physicians in Pain Management

Who is using this technology?

Contact us…

Reducing Workers’ Compensation costs…

Summary in reducing Workers’ Compensation costs…


NeuroMed is a consulting company consisting of multiple divisions that are dedicated to assisting insurance companies and health care providers with the implementation of cost effective diagnostic, pain management treatment, and other related services. We have successfully assisted hundreds of physicians across the country to achieve the most cost effective patient care.

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We are here to serve our customers!

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Understanding Workers’ Compensation Expenditures…

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Workers’ Compensation Expenditures –Insured Employers

More than 40 million people in the United States are affected with musculoskeletal pain resulting in more than 300 million physician visits, costing hundreds of millions of dollars each year. Overall, approximately 50% to 60% of the US population is either partially or totally, temporarily, or permanently disabled. Over 400 million workdays are lost each year. In the United States the number of persons reporting disabling conditions increased from 49 million during 1991 to 1992 increasing to 54 million during 1994 to 1995. During 1996, direct medical costs for persons with disabilities was $260 billion.

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A 1999 United States report of the prevalence of disabilities and associated health conditions among adults reported 44 million (22%) of the adults as having a disability. Of the total percentage of disabilities, 63% occurred among working adults; of these, 27.8 million (16.5%) had a disability and 17.7 million (10.5%) had a limitation in their ability to work at a job or business. Of those adults aged > 65 years, 16.3 million (50%) had a disability. The age specific prevalence rate of disability was the highest among respondents aged 65 or > for all functional activities, activities of daily living, and instrumental activities of daily living.

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Of all the adults with disabilities, 17.5% had arthritis and rheumatism, 16.5% had back or spine problems, and only 7.8% had cardiac or vascular problems. The cost of medical care for an elderly disabled person averages 3 times that for a non-disabled senior.

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Low back pain is a major medical problem. Worldwide, from 60% to 80% of people will have it during their lifetime and 2% to 5% will have it at any given time. In the United States, low back pain is one of the most common problems for which people visit a doctor and is the most common cause of disability under age 45. The total annual cost in the United States for health care and lost productivity is nearly $100 billion. However, only 10% of the patients account for 90% of the cost. Thus, it’s management and it’s impact on our workforce are a major drain on the American economy. Our approach to this disease must be changed.

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Reducing Workers’ Compensation Costs

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NeuroMed understands the need for change in Workers’ Compensation. Nationally, the workplace is changing rapidly: the economy is shifting from manufacturing to services; new materials, processes, and equipment are introduced every day; work weeks are longer; job security and temporary work patterns have changed.

The National workforce is also changing, becoming older and more diverse. These changes present new challenges to protecting worker safety and health and reducing the impact of work injuries on workers, their families, and society.

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Reducing Workers’ Compensation Costs

Effecting cost of Claims

According to the Workers’ Compensation Insurance Rating Bureau of California (WCIRB), a total of $35 billion in Workers’ Compensation indemnity benefits were paid during 2000 by insured employers, an increase from the $31 billion paid in 1999:

As reported by the WCIRB, Workers’ Compensation medical benefits paid during 2000 by insured employers totaled $29 billion, an increase from the $25 billion paid in 1999. The overall increase in medical benefits paid was 16%, while pharmaceutical benefits increased by 37% from 1999 to 2000.

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Our findings suggest

Heavy physical work and an increase in psychological demands are barriers to return to work during all phases of disability.

Low back pain is the leading cause of disability for people under the age of 45 and the second leading cause of industrial absenteeism. There appears to be a wide variation in the time workers stay on disability benefits and remain off work even if they had suffered similar injuries. The goal of NeuroMed is to increase the number of workers promptly returning to sustained work. NeuroMed understands that companies need employees to recover sooner and subsequently return to the workplace as soon as it is consistent with their injuries.

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The current toll of occupational injury and illness for workers, their families, and our society in general is too high. Companies are faced with new challenges in protecting worker safety and health. As the workplace and the workforce are rapidly changing, since the initiation of OSHA, some progress has been made in improving workplace health and safety.

This progress has largely been based on the science and knowledge generated by occupational safety and health research. However, NeuroMed understands that resources for occupational treatment and research are extremely limited. There is a great need to focus and coordinate existing resources more systematically and to seek expanded resources for occupational technology, health research, and guidelines.

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The most common method for the development of guidelines is based on evidence and consensus. In addition, reviews, clinical decision analyses, and economic analysis are also very commonly utilized in the medical literature. Implicit in the definition of clinical practice guidelines is that they not only be systematically and scientifically developed but also should be able to assist the practitioner and patient in making real life clinical decisions. Evidence based guideline development provides a link between the strength of recommendations and the quality of evidence.

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In developing these guidelines, all types of evidence are utilized. If an evidence based approach failed to provide adequate levels of evidence, consensus and expert opinions have been utilized.

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While an evidence based approach may seem to enhance the scientific rigor of guideline development, recommendations may not always meet the highest scientific standards. The current evidence based medicine is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research.

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It should be emphasized that, in addition to randomized controlled trials, many other factors are significant in both clinical and policy decisions. These factors, such as patient preferences and resources, contribute to decisions about the care of patients. Thus, all evidence should be considered and no one sort of evidence should necessarily be the determining factor in a decision. The “gold standard” of randomized, placebo controlled, double blinded, and independently observed prospective trials was meant to be applied only to drug trials. Next Slide

ACOEM Guidelines

According to the American College of Occupational and Environmental Medicine (ACOEM), Occupational Medicine Practice Guidelines, Second Edition, it states; "Prolonged use of narcotic medications may cause both physiologic and psychological addiction and may reduce the body’s supply of endorphins, causing depression and delayed recovery." "Pain medications are typically not useful in the sub acute and chronic phases and have been shown to be the most important factor impeding recovery of function…"

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According to ACOEM guidelines, 2nd edition on pages 105 and 106, “early recognition and effective management of pain that is out of proportion to physical damage is a critical skill in preventing excessive dysfunction, suffering, and cost.”… “Pain, whether acute or chronic, is the most prevalent health condition in the U.S. workforce and the most costly in terms of lost productive work time”… “A patient’s complaints of pain should be acknowledged.” Patient and physician should be focus on the ultimate goal of rehabilitation leading to optimal functional recovery, decreased healthcare utilization, and maximum self actualization.

With ACOEM guidelines in mind, Electroanalgesic treatments will achieve the

goals of:

Alleviating pain acute or chronic Early intervention and elimination of pain to allow

functional restoration Aids in early mobilization and return to modified or

regular work Avoidance of learned illness behaviors,

secondary gain, and malingering

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Treatable injuries

The most disabling injury in the private sector and local government is carpal tunnel syndrome with 52 and 73 median days away from work respectively although it constitutes less than 2% of injuries and illnesses in these sectors.

Although the number of back injuries decreased by 34% over a five year period (1994-1999), the back still remained the most frequently injured body part accounting for almost one quarter of days away from work.

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Treatable injuries

In the private sector, cited in about one-quarter of days away from work cases, contacts with objects and equipment was the leading cause of days away from work injuries. Overexertion was the second common cause of injury accounting for 1 out of 5 injuries.

In the public sector (state and local government) the number one cause of injury is overexertion accounting for 18% of public sector’s days away from work cases.

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Physicians Recommend

Physicians are obtaining pre-authorization for a series of 3-5 procedures called electroanalgesic treatments for the alleviation of pain. Electroanalgesic treatments are stronger and more deeply penetrating high frequencies to achieve a relatively permanent nerve block for alleviation of pain and to decrease the need for heavy narcotics to be prescribed to the patient.

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Physicians can administer Electroanalgesic procedures during the first week of treatment with emphasis on pain reduction and some mild functional rehabilitation.

Electroanalgesic treatments procedures are successful when the patient experiences an increase in activity and a decrease in the pain level by 50%.

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Upon re-evaluation, if it is documented that the patient's pain level has been reduced to a negligible level, and an increased flexibility and range of motion has been achieved, then a physician should refer the patient to a physical therapist for continued pain resolution, normalization of range of motion, neuromuscular reeducation, and overall muscle strengthening.

When a patient’s pain is under control, the above rehabilitation process will be faster and more effective allowing the patient to return to work much sooner.

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Facts You Should Know About Early

Return to Work Programs The American Occupational Medical Association's

Committee on Practice states that early return to work enhances both psychological and physical recovery.

An American Medical Association's Resolution encourages its members to release employees to work as soon as they are medically able.

Injured employees off work longer than six months have only a fifty percent chance of ever returning to their job; if time lost exceeds one year, their chances decrease to less than ten percent.

Compensable injuries can take up to four times longer for recovery; they may cost five times more than non-compensable injuries.

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Facts You Should Know About Early Return to Work Programs

Early return to work enables the employee to continue a productive life.

Early return to work reduces costs of replacing the employee, overtime costs, retraining costs, loss of production and related costs, and improves workplace morale.

Early return to work reduces Temporary Total Disability payments. Employees are on the job, earning wages.

Early return to work reduces medical costs. The injured employee heals more rapidly, shortening the time medical treatment is needed.

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Summary

In reducing Workers’ Compensation costs

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SummaryOccupational medicine providers work with employers and managed care organizations to ensure timely, safe, productive, and enduring return-to-work programs for employees with work injuries.

Using data from a number of sources, NeuroMed has constructed realistic treatment procedures addressing common work related injuries thereby reducing employer costs for work related disability. NeuroMed can demonstrate enormous financial benefit to employers who work with their managed care organizations, insurance administrators, and their healthcare providers to provide aggressive medical care.

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Summary

Medical costs are only one part of the total cost of work disability. Medical cost under usual care is the majority cost of a claim. Medical costs under usual care and care management can account for an average of up to $40,388 to $60,987 per claim per year. NeuroMed can help you target reductions in medical expenditures by expanding medical treatment usage and minimizing days off work by looking at advance technology to treat PAIN.

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Summary

Contrary to popular belief, the vast majority of chronic pain patients are managed with medication. In 1999, more than 3 million prescriptions were written for OxyContin®. Thus, the costs for OxyContin alone exceed $4,500 per year, not including related physician visits or laboratory work. Furthermore, there has been growing support for the use of anti-convulsants, anti-depressants, and topical preparations for neuropathic pain syndromes. This could add $1,500 to $3,000 per year. Further, 500,000 – 1,000,000 spine surgeries and 2 – 5 million interventional procedures are estimated to be performed in the United States each year.

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Summary

We must also conclude that lumbar epidural steroid injections and sympathetic nerve blocks produce a large amount of money, with very little science to support their application. Does this mean they are useless? Obviously not; these techniques have some value in acute pain management and should not be completely abandoned. However, their use as a mainstream (almost knee-jerk) intervention for acute or chronic low back pain does not appear to be at all justifiable at the scientific level.

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Summary

The above calculations differ for public employers, self-insured employers, and for employers from other states. They also vary according to the type of compensation paid, e.g., total temporary and medical benefits. The same general principles, however, continue to apply. Employers can work with their healthcare providers and workers' compensation administrators to find alternatives to fit their specific circumstances.

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SummaryNeuroMed considers the employer costs of work disability together with the fact that most employers eventually cover the costs for medical care for their employees. Whether their health conditions are work-related or not, NeuroMed is struck by the clear financial incentive to front-end-Ioad the healthcare delivery system. The objectives would be:

To improve the anatomical and physiological specificity of diagnoses to allow more specific and, therefore, more effective medical and rehabilitative care

To reduce and, where possible, eliminate administrative delays to diagnosis, treatment, and the return-to- work process

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Summary

To develop a treatment plan allowing for alternative or modified duty assignments and work transition programs assisting employers in managing lost work time associated with work related injuries

To develop a comprehensive industry wide procedure and treatment plan that will medically benefit the employee at the same time mitigating or ultimately reducing the employer's medical costs

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Summary

Electroanalgesic treatments are powerful tools to treat the pathology and pain. Electroanalgesic treatments are less risky than chemical blocks since the possibility of scarring at injection sites is also eliminated. Electroanalgesic treatments are useful supplemental tools for patients presented with pain and are a viable treatment option prior to chemical blocks. It is the firm belief of many pain management physicians nationally that these Electroanalgesic Treatments will replace needle (chemical block) procedures in just a few short years.

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Summary

Electroanalgesic treatments offer exemplary patient success in the treatment of PAIN, without piercing the skin. For years, many physicians have been helping patients in the Early Return to Work Program by using effective Electroanalgesic treatments with physical medicine treatment using this computer assisted High Definition frequency generator (HDfg) ™ to reduce the hyper-irritated state of the nerves.

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Summary

Physicians can administer Electroanalgesic treatments during the first week of treatment with emphasis on pain reduction and some mild functional rehabilitation. Physicians can re-evaluate the patient's condition to determine patient outcome.

Electroanalgesic treatments are successful when the patient experiences an increase in activity and a decrease in the pain level by 50%. Next Slide

Summary

Upon re-evaluation, if it is documented that the patient's pain level has been reduced to a negligible level and an increased flexibility and range of motion has been achieved, physicians will recommend the patient begin the second phase of treatment.

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Summary

This phase will consist of referring the patient to a physical therapist for continued pain resolution, normalization of range of motion, neuromuscular reeducation, and overall muscle strengthening. Treatments are typically carried out two to three times per week with a re-evaluation of the patient's condition performed after every five (5) office visits.

When a patient’s pain is under control, the above rehabilitation process will be faster and more effective allowing the patient to return to work much sooner.

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Summary

NeuroMed has successfully assisted insurance companies and health care providers with the implementation of cost effective pain care for patients. The purpose of this presentation is to stimulate interest by Self-Insured companies, Third Party Administrators (T.P.A.), Workers' Compensation, Private Insurance Companies, and the medical community in general in the cost effective use of Electroanalgesic treatments is to treat PAIN.

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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 T.E.N.S. home unit!

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

An Electroanalgesic treatment 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 inhibit 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 Electroanalgesic treatments 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)Next Slide

An Electroanalgesic treatment 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)

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What is 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.

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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. Next Slide

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. Next Slide

Szasz Slide 37


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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 .

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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).


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


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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).


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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.


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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


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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

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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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 Lumbago 724.2 Sciatica 724.3 Causalgia of upper limb 354.4 Brachial plexus injury 353.0 Lumbosacral plexus lesion 353.1 Lumbosacral root lesion,

not elsewhere classified 353.4 Next Slide

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 medical device or any other product.

Physicians must document clearly the conditions in order of importance. This medical device 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 medicine treatments. Next Slide

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What are the most common CPT codes used by physicians?

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CPT Codesused by physicians

Abbreviated list of Insurance Providers that have reviewed outcome, treatment efficacy and information provided to them by physicians nationally on patients

with pain.

Liberty Mutual Insurance Company Construction Industry Laborers Welfare Fund

Preferred Care Blue (PCBS) Cigna

United HealthCare First Health

Aetna Coresource of AZ

Performax Insurance Company PHCS Preferred Provider

St. Paul Guardian Insurance Company TEAMCARE

Lumenos St. Paul Fire & Marine Insurance Company

Blue Cross of Kansas City Cambridge Integrated Services Group, Inc.

Blue Cross of California Concentra Integrated Services, Inc.

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Reimbursement

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

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

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

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Who is using this 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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Economic benefits can favor electroanalgesic treatment methods over invasive block treatments. If 50%-75% of patients can return to work no matter how long they have had pain, society benefits through having a productive patient re-enter the work force less dependent on insurance and disability.

It is our opinion, Electroanalgesic treatments used in soft tissue injuries, that have a sympathetic nervous system component play an extremely important role in controlling pain, reducing insurance companies costs, helping patients return to work, and adding quality to patients' lives.

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Thank you for taking the time in review this information, and showing interest in our advanced Electroanalgesic Treatments as an adjunctive treatment for patients with acute and/or complex chronic pain conditions.

For a demonstration, call us…

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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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