Is the Acufacial the Ultimate Pre-Party Beauty Trick?

Found an interesting article on Vogue...


Is the Acufacial the Ultimate Pre-Party Beauty Trick?

APRIL 25, 2015 8:00 AMby MACKENZIE WAGONER

This past Tuesday, I found myself lying on my back in a Union Square healing center with nearly two dozen needles in my face. It was a remarkable experience for a number of reasons. Mostly because I am terrified of needles. To get my blood drawn, or even my ears pierced, I require the kind of coddling and hand-holding usually reserved for toddlers. So how exactly did I end up volunteering to become a human pincushion? With the Met Gala just weeks away, I’ve narrowed my focus to getting my complexion in prime glowing order, and research has told me that, in addition to giving me the kind of temporary facelift usually provided by lymphatic drainage facials and microcurrent machines, an acupuncture facial (otherwise known as an acufacial) would also fine-tune my emotional and physical state. In other words, in a mere eighty minutes, I would be getting an appointment with a therapist, doctor, and aesthetician all in one. And for that kind of time-saving, I would endure almost any form of torture.

So, at the recommendation of an editor friend, I booked an evening acufacial with NYC-based acupuncturist Soo-Mi Hwang. Borrowing from the traditional Chinese medicine technique that’s used for treating everything from osteoarthritis to back pain and stress, the skin treatment targets acupoints to stimulate the body’s regenerative process. I arrived early in hopes of calming my nerves before going under the needles. Instead, after being asked to remove my shoes, I was just as swiftly handed an informational packet that was more thorough than my 2014 taxes. Inquiring about everything from my family’s medical history, to my mental health and my dietary inclinations, the form was meant to create a 360-degree view of my hopes, fears, pores, organs, and 4:00 p.m. sugar cravings.

Why? Hwang explained that my face and skin are essentially mirrors of everything happening inside my body and mind. After setting to work painlessly placing hair-thin pins along my frown lines, my temples, jaw, and on my head, Hwang addressed the blockages in my body, referring to a kind of damming of my energy meridians. “Your stomach is very tight—that’s not a good thing,” she informed me, before putting a pin into each of my purlicues (the skin between the thumb and the index finger), which caused a brief charley horse in my hands, then released tension in my whole body and made me feel a little light-headed. “See?” said Hwang, “That’s your stomach. You hold too much stress there.”

She also placed needles in my shins (“For your chi,” she said), and one on the top of my head. Almost instantly, I felt energized. Before I knew it, the needles were removed, and Hwang was painting a skin-tightening herbal mask onto my face (“secret family recipe,” she told me when I inquired about its contents). After what felt like seconds but was actually twenty minutes, she washed it off and performed a circulation-stimulating massage, including a vigorous rubdown of the knots in my jaw and along the base of my skull.

As promised, I emerged from her studio with a radiant complexion—as well as feeling more relaxed, and with much more energy than when I arrived. In the days that followed, my sleep was sounder, and I was surprised by how loose and lucid my body felt. If that’s not the ultimate pre-party appointment, I don’t know what is. And one thing is for certain: I’ll be booking another for the morning of the Met Gala.

Clearing Acnes For Good

By Raman Kapur

Published: 26th April 2015 06:00 AM

Last Updated: 25th April 2015 12:39 PM

Acne is a common inflammatory disease of the pilosebaceous units in the skin, which often occurs in the facial, chest and back region. It is due to over secretion of androgen, dyskeratosis of conduits of the sebaceous gland and microbial infection.
Several preliminary studies have suggested that acupuncture may be effective in patients with acne.  The exact mechanisms of acupuncture in acne are unclear and may involve at least three key components—the hypothalamus-pituitary-adrenal axis, the autonomic nervous system and brain-derived neurotrophic factor. Additionally, acupuncture may act as a modulator of the immune system as he has been supported by a number of observations.
‘Ah Shi’ point acupuncture involves inserting needles at painful or pathological sites and was traditionally used for lancing furuncles.   Therefore, a study was aimed at finding out the effects of ‘Ah Shi’ point acupuncture on papules and nodules of acne vulgaris.
Researchers Young-Hee Yun, Byeong-Kook Son and In-Hwa Choi carried out a research to observe the effects of acupuncture on acne vulgaris.

The study was conducted at the department of Oriental Dermatology, Kyung Hee University, East-West Neo Medical Center in Seoul. Participants were invited through announcements on the website of east-west Neo Medical Centre and newspapers. After a thorough explanation of the procedure, informed consent was obtained from the patients who were 18 years old or more. From July to December 2009, they screened 68 applicants and enrolled 36 who met the criteria for the study.
In this study, we found that acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life.  Excessive sebum production secondary to sebaceous gland hyperplasia is the first abnormality to occur in acne. Subsequent hyperkeratinisation of the hair follicle prevents normal shedding of the follicular keratinocytes, which then obstruct the follicle and form an apparent microcomedon.
Lipids and cellular debris soon accumulate within the blocked follicle. This microenvironment encourages colonisation of propionibacterium acne, which provokes an immune response through the production of numerous inflammatory mediators.  Inflammation is further enhanced by follicular rupture and subsequent leakage of lipids, bacteria and fatty acids into the dermis Overall, they came to the conclusion that the traditional diagnoses of wind, heat, damp and insufficiency of lung, spleen or stomach are related to acne treatment, so one can treat acne using these meridians.
In conclusion, acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life.
kapuracu@kapuracu.com

http://www.newindianexpress.com/lifestyle/health/Clearing-Acnes-For-Good/2015/04/26/article2779654.ece

Acupuncture Laws, Rules, and Billing Changes

on 22 April 2015 (Source: HealthCMi)

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Several important changes to acupuncture laws and rules have recently been enacted. A 45th state in the USA has legalized acupuncture. Insurance billing requirements have changed and will see more changes before the year is out. In addition, the NCCAOM has changed acupuncture continuing education PDA (professional development activity) requirements.

North Dakota has recently passed its first law regulating acupuncture. The CEO of the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) indicates that this will help attract quality licensed acupuncturists and raise the standards of care in North Dakota. Strong efforts to legalize acupuncture in North Dakota were led by members of the North Dakota Association of Acupuncture and Oriental Medicine.

The acupuncturist scope of practice defined by North Dakota law includes patient education, botanical medicine, qi gong, tai qi, dietetics, physical forces, manual acupuncture, electroacupuncture, and thermal stimulation of acupuncture needles. All needles must be sterile, disposable, filiform needles. All acupuncturists must have completed approved graduate level training.

The NCCAOM has made a few changes to acupuncture continuing education requirements. The California Acupuncture Board has one major change for acupuncture CEUs expected later in the year. For all NCCAOM diplomates re-certifying their diplomate status as of 2016, there are changes to the safety and ethics PDA requirements. Diplomates will need two safety and two ethics category PDAs instead of four safety and/or ethics PDAs. The Healthcare Medicine Institute offers both two hour safety and two hour ethics courses online for NCCAOM PDAs.

The NCCAOM will soon institute a CPR certification requirement. This is a shift from the CPR education requirement to the official certification process. The NCCAOM notes that in 2016, “CPR is required as a stand-alone requirement in addition to 60 PDA points.” Another subtle change is to the biomedicine category. Biomedicine, as it relates to clinical practice, is now part of the core medicine category. This lifts the limit on the number of biomedicine hours an acupuncturist can accrue for diplomate renewal as long as the hours are preapproved by the NCCAOM. All biomedicine hours at the Healthcare Medicine Institute are preapproved for core category PDAs. Also, the NCCAOM has reduced the number of tai chi (taiji) and qi gong hours that may be submitted for PDAs. The 10 PDA limit has been reduced to 4 PDA points.

The California Acupuncture Board will soon require California licensed acupuncturists to obtain continuing education CEUs in the category of ethics. The specifics of the new requirements will be posted on the California Acupuncture Board website once they have been finalized. A board representative states that this may occur in the fall. Once the ethics process has been finalized, the Healthcare Medicine Institute will offer courses meeting this acupuncture CEU requirement.

Insurance Billing
Last year saw a change in acupuncture insurance billing in California. The 97800 and 97801 acupuncture and electroacupuncture billing codes used for workers’ compensation cases have been retired. The CPT (current procedural technology) acupuncture workers’ compensation billing codes have been updated to the industry standard including: 97810, 97811, 97813, 97814. Another big change to affect all medical professionals is the retirement of the ICD-9 diagnosis codes in favor of ICD-10 codes. Enactment of the new diagnosis codes is planned for the fall. To learn more about billing, visit the Healthcare Medicine Institute insurance article or take the acupuncture continuing education insurance billing course. 

There have been some unusual changes to individual insurance policies regarding acupuncture coverage. One major insurer offers acupuncture coverage but the fine print introduces a new way to deny care. Acupuncture may be reimbursed by insurance but only if it is “in lieu of anesthesia” during surgery. Currently, this policy exclusion affects over 350,000 US citizens. 

Medicare
A big question is, “Will medicare cover acupuncture?” Not yet, however, monumental breakthroughs in acupuncture research will ultimately facilitate the adoption of acupuncture into the medicare system. There are two ways acupuncture becomes part of the medicare system. The first would be an act of congress. Not much happening there. The second is based on National Coverage Determinations (NCDs). NCDs are based on research and are made by the Centers for Medicare & Medicaid Services (CMS). Current NCDs are based on outdated data. Current research will ultimately need to be considered. The HealthCMi AcuNews department is a great resource for discovering the latest findings in acupuncture research. To learn about NCDs and acupuncture medicare coverage, visit the following article: First White House Acupuncture Hurdle.

California, Maryland, and More
As a result of the PPACA, also known as Obamacare, many states now require acupuncture as a covered insurance benefit for all citizens with small group or individual health insurance plans. This is decided on a state-by-state basis and is not a nationwide requirement. California and Maryland were two of the earliest adopters of the new acupuncture policy requirement.

Pennsylvania
The Acupuncture Licensure Act in Pennsylvania has been amended. Prior to this amendment to the Acupuncture Licensure Act, licensed acupuncturists were unable to treat patients past 60 days from the date of the first acupuncture visit without a physician, dentist or podiatrist making a patient diagnosis. The new law allows acupuncturists to treat patients for longer than 60 days without a physician, dentist or podiatrist’s diagnosis if patients are free of symptoms. As a result, patients may be able to seek long-term preventative care visits from acupuncturists without first making a trip to a doctor’s office to get a diagnosis.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1456-acupuncture-laws-rules-and-billing-changes#sthash.jO6CiCfx.dpuf

Acupuncture ICD-10 Insurance Billing Codes Made Easy

HealthCMi on 17 February 2015.

- See more at: http://www.healthcmi.com/Acupuncture-Blog/1260-acupuncture-icd-10-insurance-billing-codes-made-easy#sthash.TubZsswQ.dpuf

The new ICD-10 acupuncture insurance billing diagnosis codes are mandatory beginning October 2015. This system is very different from the old ICD-9 diagnosis codes. Today, let’s go over some simple ways to convert to the new acupuncture insurance billing diagnosis codes. Learn special details in the HealthCMi acupuncture continuing education course entitled Acupuncture Billing #1.

A quick background is helpful. The ICD-10 was developed by the WHO, World Health Organization. The National Center for Health Statistics (HCHS) under the auspices of the Centers for Disease Control (CDC) is responsible for maintenance of this system. However, it is the Centers for Medicare & Medicaid Services (CMS) that develops and updates the ICD-10 diagnosis codes. The CMS has a downloadable list of all the new health insurance billing codes. The CMS “tabular list” downloadable PDF is the file that contains a quick an easy reference guide to the codes.

This article lists some of the most common ICD-10 codes you will need in the acupuncture clinic. These codes may change over time because it is a relatively new system. For the complete list, access the CMS PDF files at: http://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

Pain codes are usually reimbursed by insurance companies. General internal medicine conditions such as lupus, IBS, infertility, etc... are often rejected. The new ICD-10 code set does not change this bias. It is up to individual health insurance providers to determine the diagnosis codes that are deemed reimbursable for licensed acupuncturists. 

There may be a bit of a of a guessing game in the very beginning of ICD-10 implementation. How can this be? The old ICD-9-CM codes ranged from 3-5 characters. There are specific conventions developed to determine whether a 3, 4 or 5 digit code is reimbursable in the old ICD-9 system. The new ICD-10 system consists of 3-7 characters. The dust has not settled on whether some 3, 4 and 5 digit codes will be acceptable over more lengthy 6 and 7 digit codes. No worries, let’s take a look at how to make sure there is more certainty in the process. We start by looking a why certain codes are more commonly reimbursed than others. 

There are several insurance companies, including Cigna, that accept only a limited number of diagnoses. Currently, Cigna readily reimburses for neck pain, low back pain, nausea due to chemotherapy and nausea due to morning sickness. Anthem (Blue Cross-Blue Shield) tends to reimburse for a wider variety of diagnosis codes. However, their clinical utilization review guideline published in 2013 stipulates:

The use of acupuncture is considered medically necessary for treatment of nausea and vomiting associated with surgery, chemotherapy, or pregnancy provided the individual does not have either of the following:
• Pacemaker; or
• Automatic implantable cardioverter-defibrillator (AICD)

Anthem also stipulates:

The use of acupuncture is considered medically necessary for treatment of painful chronic osteoarthritis of the knee or of the hip, if all of the following criteria are met:
• Radiographic evidence of osteoarthritis; and
• Pain significantly affecting daily activity and function.
• Absence of ALL of the following: Other metabolic, inflammatory, or infectious causes of arthritis; Pacemaker or AICD; No plans for total joint replacement 

Next, the official Anthem guidelines stipulate, “Acupuncture for any other indication, including but not limited to, the treatment of pain other than specified above, is considered not medically necessary.” This goes towards explaining why some pain related diagnosis codes are rejected. That said, most pain codes are reimbursed by Anthem whereas Cigna tends to adhere to strict and narrow guidelines.

Neck pain is the first place to start. Most insurance carriers will not balk at the use of cervicalgia as a diagnostic specification. The new cervicalgia ICD-10 code is M54.2, a simple 4 character alphanumeric code. There is no extra digit ambiguity in this case. Sciatica is another story. The basic ICD-10 sciatica code is M54.3. This might be denied because there are five character versions of this code:

M54.30 Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side

This is an example of a new feature in the ICD-10 system. Laterality may be specified. In this instance, the 5th character designates an unspecific side with a 0, right with a 1 and left with a 2. It is probable that a five character code is going to cause less problems than the four character code. Nobody wants to rebill! 

Low back pain is perhaps one of the most universally accepted diagnoses. Low back pain is M54.5 and includes loin pain and lumbago NOS. The NOS indication means “not otherwise specified” and refers to the generality of the unspecified disorder. Lumbago NOS is understood as generalized low back pain, unspecified. The M54.5 low back pain code excludes low back strain, which is an S39.012 ICD-10 code. All of these codes can be easily found in the downloadable “tabular list” document from the CMS. The download is free and searchable because it is in the PDF format.

PDF documents are familiar to acupuncturists using the HealthCMi acupuncture CEU system for acupuncture CEU and acupuncture PDA online courses. Most HealthCMi course content is distributed in PDF format. PDF reader software is free and can be downloaded at Adobe’s website. If you are viewing PDFs on the Google Chrome web browser, you may only see the first page of the document. If this occurs, go to Chrome’s settings and enable the PDF plugin.

Acupuncture services are often reimbursed for the treatment of headaches. The R51 Headache ICD-10 code includes facial pain NOS but excludes atypical face pain (G50.1), migraine and trigeminal neuralgia (G50.0). The migraine code (G43) requires extra character specificity and excludes headache NOS (R51) and lower half migraine (G44.00). The following are a few of the common migraine ICD-10 codes:

G43.009 Migraine without aura, not intractable, NOS
G43.109 Migraine with aura, not intractable, NOS
G43.409 Hemiplegic migraine, not intractable, NOS
G43.709 Chronic migraine without aura, not intractable, NOS
G43.909 Migraine NOS

The list for migraines is quite lengthy but a few codes should meet most office needs. It is expected that most carriers will continue to reimburse for the treatment of headaches and migraines. There are codes for conditions commonly treated at acupuncture clinics such as G47.00 (insomnia NOS) but, not being a pain code, it may get rejected.

The following is a short list of some other handy ICD-10 codes:

M76.50 Patellar tendinitis, unspecified knee
M76.51 Patellar tendinitis, right knee
M76.52 Patellar tendinitis, left knee
M05.33 Rheumatoid arthritis
M15.9 Polyosteoarthritis, unspecified (generalized osteoarthritis NOS)
M16.10 Unilateral primary osteoarthritis, unspecified hip
M54.40 Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.6 Pain in the thoracic spine
M54.9 Dorsalgia, unspecified (backache NOS, back pain NOS)
H57.1 Eye Pain
R10.2 Pelvic and perineal pain
R07.0 Throat pain
K08.8 Tooth pain
F45.42 Pain disorder exclusively related to psychological factors
R51 Headache NOS
G44.019 Cluster headache syndrome NOS
M75.20 Bicipital tendinitis, unspecified shoulder
S43.429 Sprain of unspecified rotator cuff capsule
M75.00 Adhesive capsulitis, unspecified shoulder (frozen shoulder)
M77.20 Periarthritis, unspecified wrist
G56.00 Carpal tunnel syndrome, unspecified upper limb
M72.2 Plantar fascial fibromatosis (plantar fasciitis)
M79.7 Fibromyalgia
M54.1 Brachial radiculitis NOS
M54.1 Lumbosacral radiculitis NOS
M79.601 Pain in right arm
M79.602 Pain in left arm
M79.603 Pain in arm, unspecified
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.606 Pain in leg, unspecified
M79.609 Pain in unspecified limb
M79.643 Pain in unspecified hand
M79.646 Pain in unspecified finger(s)
M79.673 Pain in unspecified foot
M79.676 Pain in unspecified toe(s)
M77.10 Lateral epicondylitis, unspecified elbow (tennis elbow)

Non-specific codes regarding laterality such as M79.643 (pain in unspecified hand) may be adequate. However, time will tell whether or not the codes must specify left or right. Pain in the left hand is M79.642 and pain in the right hand is M79.641. 

- See more at: http://www.healthcmi.com/Acupuncture-Blog/1260-acupuncture-icd-10-insurance-billing-codes-made-easy#sthash.TubZsswQ.dpuf

Stanford University, Acupuncture Reduces Pain After Surgery

on 12 April 2015.

Stanford University doctors conclude that acupuncture during surgery reduces pain. Research published in The Laryngoscope finds acupuncture effective for reducing pain and improving restoration of a normal diet postoperatively when acupuncture is applied during surgery. Doctors from the Stanford University School of Medicine conclude that acupuncture is “feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively.”
The research was conducted by doctors from two Stanford University School of Medicine (Palo Alto, California) departments, the Department of Otolaryngology-Head and Neck Surgery and the Department of Anesthesia.
A randomized-controlled investigation of acupuncture’s benefits to pediatric tonsillectomy patients reveals that acupuncture patients “experienced significantly less pain at various postoperative time points as compared to the control cohort, and also that the onset of analgesia in the acupuncture cohort began by 36 hours postoperatively, whereas the control group did not reach significant analgesia until 84 hours postoperatively.”
Postoperative oral intake improved for patients receiving acupuncture during the tonsillectomy operation. The researchers note, “Oral intake was significantly more improved in the acupuncture group than the control group (P = 0.01).” They add that “the acupuncture group had significantly increased oral intake starting at 24 hours and lasting through all remaining time points examined, whereas the control group had significantly increased oral intake starting at 72 hours postoperatively.”
Measures of intraoperative acupuncture on nausea and vomiting did not produce significantly different results for the acupuncture and control groups. Out of a total of 59 patients, five acupuncture group patients experienced nausea or vomiting. Similarly, seven control group patients experienced nausea or vomiting. The researchers note that the numbers are not statistically significant (P = 0.12). Overall, the researchers note that the rates of nausea and vomiting were “very low” for both groups and that this may be attributed to “other factors in our regimen” including surgical techniques, gastric suctioning, etc… The researchers comment, “We do, however, find the differences between the treatment and control groups in postoperative pain scores to be clinically significant, particularly when treatment resulted in an earlier improvement of oral intake.” 
Researchers note that no adverse side effects from acupuncture occurred. They comment that only sterile disposable acupuncture needles were used, adding that this may have averted adverse effects. The researchers note, “Complications related to acupuncture are very rare….” In many states, including California where the investigation was conducted, only sterile disposable needles are legal for use during acupuncture. Although autoclaving sterilizes needles, reusable needles are not used in California and many other states. Single use sterile disposable needles have quickly become the national standard in the USA. The American Association of Acupuncture and Oriental Medicine (AAAOM) and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) “note that not a single death has been reported to result from acupuncture in the US.”
The Stanford University researchers note that the study of acupuncture during surgery is a “relatively new area of research.” They add, “One of the strengths of this study is its rigorous double-blinded randomized design with a sham acupuncture control.” Based on the positive patient outcomes for both pain reduction and oral intake restoration, the researchers suggest further studies with larger sample sizes.
Acupuncture Procedure
Electroacupuncture was applied intraoperatively at alternating frequencies between 4 and 100 Hz with a Pantheon Research stimulator. Electroacupuncture connected acupoints LI4 (Hegu) to ST36 (Zusanli) and P6 (Neiguan) to TB5 (Waiguan). Electroacupuncture was also applied to acupoint KD6 (Zhaohai). The researchers comment that alternating frequencies between 4 and 100 Hz were utilized to “optimize the release of endogenous endorphins, enkephalins, and dynorphins.” ST36 was chosen for its “analgesic properties,” LI4 and KD6 were chosen for their analgesic actions on the throat, head, and neck; and PC6 was chosen for its antiemetic properties. All needles were inserted to a depth wherein a deqi fascial grab was achieved. The needle depth ranged between approximately 0.5 - 1.0 cun.
Acupoint HT7 (Shenmen), located on the wrist, was added for its ability to reduce “postoperative agitation.” No electroacupuncture was added to HT7 or auricular acupuncture points. Seirin brand auricular acupuncture “junior tacks” were added to outer ear points shenmen, master cerebral, cingulate gyrus, and tonsil.
The double-blind, randomized, placebo-controlled study finds intraoperative acupuncture effective for reducing pain and improving postoperative oral intake. Integration of acupuncture into the operatory was also found both feasible and well tolerated. Funding sources are the Stanford University Medical Scholars Research Program, Howard Hughes Medical Institute Medical Fellow Program, and the Stanford Children’s Health Research Institute Akiko Yamazaki and Jerry Yang Faculty Scholar. Disclosures note that no conflicts of interest or other sources of funding or financial relationships exist. The research is published in The Laryngoscope, a publication of The American Laryngological, Rhinological and Otological Society.

Reference:
Tsao, Gabriel J., Anna H. Messner, Jeannie Seybold, Zahra N. Sayyid, Alan G. Cheng, and Brenda Golianu. "Intraoperative acupuncture for posttonsillectomy pain: A randomized, double‐blind, placebo‐controlled trial." The Laryngoscope (2015).

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1452-stanford-university-acupuncture-reduces-pain-after-surgery

Veterans decrease pain with alternative medicine

http://www.chillicothegazette.com/story/news/local/2015/04/14/veterans-decrease-pain-alternative-medicine/25752717/

My first acupuncture experience - ChicagoNOW.com

http://www.chicagonow.com/ups-and-downs-of-a-yoga-mom/2015/04/my-first-acupuncture-experience-and-why-i-will-be-going-back-next-week/

MRI shows acupuncture relieves migraines

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1453-brain-mri-shows-acupuncture-relieves-migraines