The Munnelly letter – The proper reimbursement for MUA services

17 Responses

1. Unfortunately my mother is in the hospital due to a stroke. She received a CT Scan along with a number of other tests. They do not have an open MRI machine. My mother lived in a bomb bunker for some months during her childhood and cannot endure a closed MRI. The solution was anesthesia.

   My sister, who is a Pediatric Intensive at Children’s Hospital in Phillie; highly published; the recipient of many multi-million dollar grants including pharmaceutical companies and the NIH; also an invited member of the FDA Board (sister to a proud Italian boy) — she said “no dice.” To much risk for minimal reward. (The CT scan would pick up “gross abnormalities”) Schedule the MRI as an outpatient procedure.

   What type of UA is this and is it worth it.

   1. I always had this fear about general anesthesia. There is the initial worry about not waking up after it is administered. Also, I worry about what is actually happening to me while I am under. It is just scary stuff. To me, this procedure should be rarely done. Do you have open heart surgery because there is a partial occlusion in your left ventricle? I don’t think so. Same thing here.

2. That does sound crazy to knock someone out for an MRI. Of course, there is always a risk someone who goes under will expire. I’m sure the hospital would want to do it in house. Zuppa, MUI concerns a spinal “manipulation.”

3. in the modern world, anesthesia is generally very safe. Propofol is one hell of a drug (even though it killed MJ).

   While you cant rule out something happens while youre unconscious, there are several people in the room so you dont usually have to worry about anything too horrible.

4. Boys I will talk to my sister and list all the side effects including disorientation which is common to the other more dangerous side effects that are less common — such as perpetual insomnia.

   1. Ray,

      I never thought the day would come where I would see “eye to eye” with you on a no fault issue.

5. B.S. is B.S. I’ll point it out anytime. Maybe things would be better at the term if we didn’t have some of this piggy wiggy nonsense. However the law should still be respected and followed and form the basis for decisions. Nevertheless if you need to be put under to endure chiro that’s crazy and if true forget the chiro.

   Hence my earlier Rogakian comment about needing psych treatment to help with the trauma brought on by the chiro treatment which is being utilized to treat the physical trauma from the car accident.

   Everyone who gets into a car wreck is going to turn into M.J. We’ll have accident patients moonwalking down Coney Island Avenue.

   Maybe we can give some of that stuff to the IME and Peer Docs so they can moon walk into the court.

   1. You know that I am an avid defender of chiropractors and am hoping comp finally gets them up to $60 for a 99213.

      That being said, I am really leery about MUA. I know there has been an uptick in surgery cases, because they can add significant value to the underlying personal injury case. So perhaps the Claimant has a monetary reason to undergo medically unnecessary surgery. I get that. But MUA? Does that add value to a case? I cannot see a plaintiff attorney during summation telling the jury during the damage phase of a BI case that his client’s injury was so bad that his client had to go for three days of MUA. I think most jurors would shake their heads.

      So if the Claimant does not even see a monetary benefit to it; does not even know many times why (s)he is undergoing it; and there is a real risk of getting killed while under – why is it being done so often. I will put my cynicism aside right now.

      The moonwalk in Brighton Beach. I love it.

6. Do we have any chiros or physicians in the house who can discuss the benefits and drawbacks of an MUA? It’s clearly a properly billable procedure, assuming lack of medical necessity is not established.

7. Doctor Zuppa in the house. I looked into this and learned that which you all already know. This is a full knock out anesthetic. Out cold. “You don’t sleep to dream.”

   Do you know what has to be done before you can do that in a hospital. The diagnostic tests before you receive clearance. The time in the recovery room. The consent wherein you acknowledge this may be The Big Sleep. (Bogart and Bacall) The blood clot risk, etc., etc. The disorientation — massive — for hours afterward.

   I looked into a case where they were billing for three knockouts a week on one patient. The per diem lawyer that tried said she was digusted.

   Folks I used to see a chiro during my football days. It came with being on the team. Non No Fault. The guy was being paid a flat salary by the team. No incentive to go fast. 10 to 15 minutes soup to nuts. The manipulation cannot take over a few minutes unless you want the guy to cripple you.

   I don’t want to turn this into my cause celebre but MUA should = criminal assault with a stupid brain.

   Providers are getting a bad rap as a general matter. We don’t need this kind of B.S.

   I can see it. Billing for MUA. We custom fitted the LSO while he was under. Since he was under we did the needle EMGs to take care of that fear. And to wake him up we did aqua therapy in a very cold pool. Next we gave him a vodka enema and massage therapy [edited for content] He left [edited for content].

   1. I suppose my hope is that with the reimbursement of this procedure to the chiropractors being minimal according to the comp board, we might hopefully see less of this procedure. That is my fervent hope.

8. “Happy End” is a play written by Bertold Brecht and Kurt Weil. It is a musical comedy. A Chicago Mob version of Guys and Dolls. It was my first professional acting job. Just because I put an “ing” at the end should not warrant editing. I did not cuss.

   Oh I love it J.T. I having so much fun here. I love you much to your chagrin.

   1. I have to edit your comments, sometimes, because I cannot let this blog look like some of your legal briefs that the Appellate Term has “cautioned” you about. I also realize that you justify some of your comments through the device of the double entenrdre. Still, this is not the Match Game; it is a legal blog. Yet, you add humor to some slow weeks in the world of no-fault practice.

      But, I am very pleased that you have seen the light (or the darkness) of MUA. Was there a publicized case a few years ago when someone went into permanent darkness due to the performance of MUA?

9. Sorry J.T. you’ve never read the briefs so you wouldn’t know. They aren’t like that at all. In fact in light of what the insurance henchmen said about my client what I say is justified. I am just on the wrong side of the political wind.

   The last round of cautions was totally unjustified.

   You know J.T. my first football game … you could learn a lot about life from playing football — too bad you were on the badmitton team — but anyway during the game my team mates started complaining about fouls. The coach yelled “You take care of it on the field.”

   Now I think you are totally wrong with the low reimbursement for knock out chiro. And I take serious issue with you. And I think you are being callous.

   What will be the end result J.T. Corners will be cut J.T. Instead of somewhat of a check up to see if you can take what M.J. called “the milk” you’ll have the low rent heart rate: ten seconds of your pulse times 6. Instead of a chemical agent the anesthetic effect will be produced by a mallet blow to the temple. Instead of the recovery room you’ll get the salty air of a sidewalk next to Sheepshead Bay.

   Just outlaw it.

10. its not gonna get outlawed. there are definitely times when it is the correct treatment.

    If a DC, who usually gets $40, can bill $2500 per day of MUA, you have to believe hes going to seriously consider his patients as candidates.

11. $2500 per day of MUA. Times 20%. I have been thinking this issue over and I must admit that I am no doctor. I am barely a lawyer. What do I know about medicine. And my sister is no anesthesiologist — see I cannot even spell it. [Editor’s note – I used spell check and fixed the spelling -JT]

    If the Munnelly letter says its okay I must defer. We must all defer. See Serio vs. Dinallo vs. Zuppa vs. Wrynn.

    So any chiros out there who practice MUA contact me and I will give you the best representation possible.

    1. Ray,

       Why do I post your comments? I think I pose them because they are amusing and actually (beyond the hyperbole) have a greater meaning….