March 2002

What You Might Not Know About Nutrition
Updates on CPT Codes, and How to Educate Your Patients
By John Lockenour, DC, DABCO

Many Americans don’t need to be “sold” on the importance of nutrition. U.S. health-care consumers are already spending more than $15 billion a year on nutritional supplements (Nutrition Business Journal - 2000), and that number continues to grow. Unfortunately, much of what these consumers are buying is based on media hype or impulse buying. That’s why they need your guidance.

For more than 100 years, chiropractors have been educating their patients concerning health maintenance, including: proper rest, exercise, diet, attitude, and most importantly, a balanced nervous system. Many doctors of chiropractic spend at least a portion of their time educating patients about what nutritional supplements would be best for a specific condition or to help prevent the onset of disease.

With chiropractic’s “whole body” approach to health, who better to be advising patients concerning supplements? Their MD or DO probably doesn’t have the training or interest to advise them. The mainstream media and the Internet can’t be trusted to present reliable, documented research on what is advisable. And the local health-food store employee usually has very little, if any, formal training.

As a chiropractor, chances are good that you know your patients’ nutritional needs better than anybody else. You can also sort through all the hype and false claims and help advise your patients what would be best for them and what research has proven to be effective.

Our first responsibility is to educate patients and the public concerning the need for proper diet and nutritional supplementation. Some excellent ways to educate patients can be addressed every day in your office. Such tools as: reception room displays, on-hold telephone messages, reception room educational videos, and electronic reader boards are simple, ongoing ways for patients to assimilate information.

Create an “Information Center” in your office that has pamphlets, articles, research, and cassette tapes concerning current hot topics in nutrition. Create a “Lending Library” of quality educational books that will educate patients on subjects that can be addressed nutritionally, such as: fibromyalgia, chronic fatigue syndrome, hyperlipidemia, hypoglycemia, hypo-adrenal syndrome, chronic systemic yeast, and so on. You can also include information on preventive nutrition as related to: cancer, atherosclerosis, arthritis, and premature aging.

Send a quarterly newsletter via U.S. mail, fax, or e-mail to all your patient base, with timely articles educating your patients about why chiropractors are the best health advisors for their nutritional needs. Make sure you also provide the quarterly newsletter in your reception area, at health talks and any other outside marketing activities, new patient packets, wellness classes, and anywhere else you like. You may also want to look into having the newsletter inserted in your local newspaper using zone marketing.

It’s the chiropractor’s responsibility to find the most cost-effective way to determine what nutrition would benefit a particular patient with specific disorders or conditions. You should create your own “cookbook” and a “this or that”-type approach as a starting point, and then modify it for each patient’s individual needs. Nutritional recommendations such as vitamin B-6 for carpel tunnel syndrome, glucosamine for osteoarthritis, and niacin or hyperlipidemia have been used effectively for years. Make a note of this type of information as you read authoritative sources or attend nutritional seminars.

You can also develop a Symptom Survey and/or computer-based questionnaires, which can help give you insight into where your patients’ major problems or needs exist. If you choose to use them, tests such as applied kinesiology or contact reflex analysis can provide indications of where there are major dysfunctions in the body. Many traditional testing methods such as: blood and urine analysis, body fat analysis, and bone density testing can help document health problems. In my experience, a combination of testing methods has shown to be the most effective way to determine the needs of patients and to monitor their response to treatment.

The latest edition of “CPT 2002” has made provisions for third-party payers to be billed for “Medical Nutritional Therapy.” The verdict is still out as to how well third-party payers are going to reimburse for these services; but, we now have a code to represent what we do.

These codes are as follows:

• 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
• 97803: Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes.
• 97804: Group (two or more individuals), each 30 minutes.

Implementing these services into your practice can give your patients greater results with your chiropractic care, and it will help make you the expert in nutritional healthcare in your area.

Dr. Lockenour practices in Bedford, Ind., and is a speaker for Kats Management. He was the 1991 and 2000 Indiana Chiropractic Association Chiropractor of the year, and was formerly on the postgraduate faculty of a number of chiropractic colleges. He can be reached through Kats Management at 800-843-9162; info@katsmanagement.com; or sign on to www.katsmanagement.com.