EMS vs. TENS after Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of my time treating patients injured in Baltimore auto accidents, I often get asked what the difference is between EMS and TENS. These are acronyms used for two common pain modulating modalities. EMS stands for electric muscle stimulation. TENS stands for transcutaneous electrical nerve stimulation. In my clinic we utilize EMS following Baltimore auto accident injuries. So whats the difference?

EMS uses a cycle of electrical current that allows the muscles to contract and relax, increasing blood flow and promoting healing. It helps to relax spasmodic muscles and sooth the deep ache of muscle pain such as that experienced in Baltimore auto accident whiplash injuries. As the name implies, the purpose of the EMS modalities to stimulate injured and atrophied MUSCLES. There is also a pain modulating effect, but it is not the primary goal of EMS. EMS helps to improve ranges of motion as well by reducing swelling. You can see a picture of an EMS machine here.

TENS is thought to promote the production of ATP at a cellular level by stimulating NERVES and helping to modulate pain by overriding the sensation of pain prior to its interpretation in the brain. Typically speaking TENS units are usually sold over the counter and can be worn conveniently on a belt clip and can be taken with you. You can see a picture of a TENS unit here.

Truth be told, utilizing either TENS or EMS following a Baltimore auto accident injury will help you regardless of which you choose. I often tell patients in pain following injuries that if they have a machine at home, regardless of which one they have, that they are better off using the machine than not using it. EMS gives the treating provider a few more options to help with muscle spasm and pain, but TENS works just fine.

Despite the benefits of TENS and EMS, not every injured patient can utilize these therapies. Patients with open wounds, eczema, patients with pacemakers, or pregnant women (over a gravid uterus) can not utilize these modalities for pain.

If you, or someone you know, is suffering from muscle and/or nerve pain following a Baltimore auto accident injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

ICD-10 Coding for Baltimore Auto Accident Injuries

Since approximately 1979 the health care providers in the United States have been using a series of 4 and 5 digit codes to represent our diagnoses for patients. This code base is called ICD-9, which stands for International Classification of Disease, 9th edition. For example, I may diagnosis a sprained neck as 847.0 cervical sprain/strain. While it is fairly fast and easy for Chiropractors such as myself to code with just four digits, it is not entirely accurate. That is, if someone sprains the zygapophyseal joints in their neck following a Baltimore auto accident, why should it be coded with the same codes 847.0 that also reflects a strained upper trapezius muscle? The problem with the “old way” of coding for health care was that one code pointed to many different conditions. And then, there’s the problem of “sidedness”. If someone were to sprain their right shoulder (840.9) or their left shoulder (840.9) there would be no way based on the numbering scheme to know which side was actually injured.

That’s where ICD-10 comes in. With the exception of the United States, the rest of the world has already moved on from ICD-9 and has implemented and been using ICD-10 diagnoses for years. Much like our desire to avoid the metric system, the U.S. has been burying its proverbial head in the sand and has only JUST NOW decided to implement a transition to ICD-10 coding.  As of October 1, 2015 (approximately 16 days away as of the time of the writing of this blog post) all new diagnoses for patients need to be coded in ICD-10 rather than ICD-9. Let’s take a look at some of the perils of this “instant transition.”

Hypothetically I could be treating a patient on September 30, 2015 and I can diagnose them with a cervical segmental dysfunction (739.1). If they return for treatment the following day on October 1, 2015 that same person with the same diagnosis is now considered to have a “segmental and somatic dysfunction of the cervical spine” (M99.01). That’s not too bad…

Let’s look at the cervical sprain/strain example from above. If that patient presents for an evaluation on or before September 30, 2015 their diagnosis would be 847.0. However, should they present on or after October 1, 2015, their diagnosis is now “Sprain of ligaments of cervical spine (S13.4xxA) (initial encounter) with strain of muscle, fascia, and tendon at neck level (S16.1xxA) (initial encounter)”. While it does make the diagnosis more specific, where one disease process is mapped to one code, it makes coding as a whole more difficult.

As far as the sidedness argument. If a patient comes in and sprains both shoulders in a Baltimore auto accident on September 30, 2015, then they will be diagnosed with 840.9. If, however, they came in on October 1, 2015, they would have two separate diagnoses, one for the sprained right shoulder, and one for the sprained left shoulder. And if it is “more than” just a sprain, that is if there is any muscular involvement, we would have to code for both the sprain and the strain component of the injury, which is not uncommon. So here is what it would look like:

Right shoulder rotator cuff sprain (S43.421A) (initial encounter)
Left shoulder rotator cuff sprain (S43.422A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of right shoulder (S46.011A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of left shoulder (S46.012A) (initial encounter)

In that previous example, it is clear that 1 code (bilateral shoulder sprain/strain) mapped to four separate codes, inclusive of the right vs. left side shoulder and inclusive of the sprain (ligamentous component) vs. strain (muscular) component of the injury. While it is not that difficult to hit a few buttons on a keyboard, you can see how it makes diagnosis coding way more complex.

As with any transitions, errors and omissions will be made. These errors will not only be made by me and my staff but by health insurance companies, third party payors, patients, etc. It is not feasible to transition to an entirely new language over-night without a few bumps in the road. Gurus in the insurance industry are predicting a cash flow interruption for small offices of anywhere between 3-6 months worth of normal cash flow as the mistakes get ironed out.

So what does this mean for the auto accident injury patients of Baltimore and more specifically, of Mid-Atlantic Spinal Rehab & Chiropractic? Absolutely nothing!

Our proprietary software has the ability to duly code in both ICD-9 and ICD-10 languages and will retain that ability moving forward. You will still be bound by the contracts you signed with your health insurance provider and will still have to pay copays, deductibles, etc. Literally nothing changes other than the codes we use to record your injuries. So rest assured, it should be business as usual moving forward.

If you, or someone you know, is experiencing neck or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

The Role of Traction in Recovery From Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of his time treating patients recovering from Baltimore Auto Accident Injuries I get asked many of the same questions each day. It finally occurred to me that I should address these common questions in a series of blog posts on my website. That way a patient can know what I am going to say before I say it (and it will keep me from repeating myself.).

One of the questions I get asked most frequently is whether or not my office offers “traction” therapy. The answer is quite simple, “yes, we do.” However, the question is somewhat incomplete. That is, there are two different types of traction that we offer and each are used for different types of injuries. Let me explain.

The first type of traction that most patients are referring to is called “mechanical traction.” A picture of a mechanical traction machine that I might use on a Baltimore auto accident injury patient can be seen here. It is a table where a patient is harnessed down such that their torso is fixed, and a gentle mechanical stretch can be applied to the neck, or conversely, their torso is fixed and a gentle mechanical stretch can be applied to their lower backs. I generally will use mechanical traction as a form of therapy when patients either fail to improve with traditional forms of chiropractic care and rehabilitation, or when traditional spinal manipulation is ill-advised. Many of my Baltimore auto accident patients with neck disc herniations or lower back disc herniations swear by mechanical traction to help open up their locked joints and to take pressure off of their inflamed discs. The machine is somewhat cumbersome and it takes about 20 minutes from start to finish between setting an injured patient up on the machine, and administering the desired traction effect. As far as I am concerned, as long as it helps my injured Baltimore auto accident patients then it is time well spent.

The second type of traction that we offer is called intersegmental traction, or more colloquially, the “roller table.” A picture of an intersegmental traction table (or IST table) that I might use on a Baltimore auto accident injury patient can be seen here. It is a machine that has a series of massage-type rollers on a moving conveyor belt. It travels from your neck, through your middle back, and down to your lower back. It focuses on lifting and gently separating all of the spinal segments of your spinal column, one by one. The nice added benefit from utilizing an intersegmental traction table is the soft tissue paraspinal massage that it offers the patients utilizing it. Many patients refer to their time on the IST table as their “favorite part of their treatment.” They feel relaxed, looser, and a lot less stiff.

In future blog posts I will address other modalities and therapies that we offer, as well as other commonly asked questions that commonly arise during Baltimore auto accident injury treatment at Mid-Atlantic Spinal Rehab & Chiropractic.

If you, or someone you know, has been injured in a Baltimore auto accident injury and requires treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Concussions and Non-Musculoskeletal Injuries Following Baltimore Auto Accidents

As a Baltimore Chiropractor that spends the majority of my time treating patients that have been injured in Baltimore auto accidents, I spend a lot of time diagnosing and treating traditional whiplash symptoms including headaches, neck pain, mid back pain, and lower back pain. One set of injuries that often go overlooked following Baltimore auto accidents is concussions and their symptoms.

Contrary to popular belief you do not need to have struck your head on an object in the vehicle (i.e. head hitting a head rest following rear-end collision) nor do you have to have lost consciousness in order to have a concussion. All you need is there to be contact with your brain and the inside of your skull. You can think of a concussion as a “brain bruise” and depending on where your brain impacts your skull there can be many different symptoms associated with a concussion.

There are several different type of concussive symptoms and rarely are two concussions the same in the same person. In no particular order here is a list of concussion symptoms:

• Headaches/head pressure
• Mental “foggy” feeling
• Amnesia- Trouble remembering the impact
• Confusion
• Dizziness
• Ringing in the ears
• Nausea
• Vomitting
• Slurred Speech
• Sleeping too much or too little compared to normal
• Fatigue
• Irritability
• Decreased appetite
• Anxiety
• Personality changes- people may say that you “don’t seem like yourself.”
• Apathy/Lack of Interest in joyful activities
• and many more

The difficult thing about concussions is diagnosing them. That is, there is no blood test for concussion. The best people to talk to about whether or not there have been behavioral changes that may indicate a concussion are the patient’s family and friends. That is, they knew the injured party when they were behaving normally and they know them now. This can help you understand any changes that may have taken place.

Due to the difficulty in diagnosing concussions conclusively, I routinely refer my suspected concussion patients out to a neurologist for evaluation. These neurologists can run a series of examinations, confirm or deny my suspicions, and even run T3 brain MRIs to confirm physical evidence of concussion.

Following a Baltimore auto accident it is easy to pay attention to physical injuries. Anything that can be “seen” as a physical injury and can be understood by most people. Concussive head injuries are difficult in that you can not see them in the person. If you have suffered a concussion as a result of a Baltimore auto accident injury do not simply neglect to tell your treating providers about your condition. Your very recovery may depend on it.

If you, or someone you know, has suffered from a Baltimore auto accident injury and has suffered a concussion please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz