Office Updates

As we're saying goodbye to October and hello to November, I would like to share a couple of current office updates and future plans.
​

​an update on phone numbers

For some reason, about a month ago my schedule got very chaotic with patients being scheduled at the wrong clinic (ex: they wanted to see me in Salem, but ended up on my Portland schedule).

Now I've known this could happen, since I work at two separate locations under one practice name, but it's never been too much of an issue before.

I believe now staff are confirming location a little bit more during phone calls ("for the Salem office, you're wanting to see her at the Salem office, right?"), so it looks like everything has smoothed out.

But just in case you don't have both phone numbers, here they are:
Portland: 503-232-3215
Salem: 503-990-8395

We were considering "closing down" the schedules at the respective clinics (Portland staff would only be able to schedule me for my Portland schedule), but it seems like the chaos has calmed down. In any case, please at least save into your phone the number for the office you physically see me at, and call that one when you're scheduling follow-ups.

updates around the office

Some days I will have a colleague or medical intern shadowing me. For the most part they are all looking to further develop their injection therapy skills, or exposing themselves to this field in order to learn more about it (and decide whether to pursue it post-graduation).

I strive to respect everyone's needs and boundaries, so during the days I have someone in the office with me, I do a quick check with each patient as soon as they get here (for injection procedure and/or re-evaluation follow-ups post-injections). I check in to see whether they are comfortable having someone observe the entire visit, just the injection procedure component, or not at all.

That way there are no surprise visitors during visits, and my colleagues/ students get observation experience with those who feel comfortable with them being present.

​a few more office updates

Alpha Stim
I have been doing a lot of research into different in-office electrotherapy devices, such as cranial electrotherapy stimulation (CES), transcranial magnetic stimulation (TMS), and vagus nerve stimulation devices.

After a lot of careful consideration, I have decided to offer Alpha Stim at both of my clinics.This is a CES device that is FDA-cleared for anxiety, insomnia and pain.

I will start offering these 30-minute sessions during office visits (you can schedule a typical in-office follow up for this).

When treating anxiety, depression, or insomnia, those sessions can be billed to insurance (limit: 4 sessions). That way I can offer a more approachable trial run for this device to my patients, and those who benefit can decide whether to obtain one from my office or the Alpha Stim company for at-home use.

Ketamine
I have been following the research and medical use of ketamine for the last few years with a lot of interest.

As this field develops, we are seeing more evidence-based uses of ketamine for pain, insomnia, anxiety, and depression.

I am often brainstorming with patients more and different options after chronic pain management or conventional mental health treatment of therapy and pharmaceuticals have been exhausted.

There is of course no one magic bullet for any of these complex chronic concerns, but I am interested in learning more about it, as it could be one more additional treatment option I can offer my patients.

I will only be offering oral options, which should be used in conjunction with ongoing mental health counseling. I will not be offering it IV.

Here are a few articles on some of the medical uses of ketamine, if you are interested in learning more:
https://www.medrxiv.org/content/10.1101/2020.07.13.20153247v2.full
https://www.nature.com/articles/s41398-021-01230-z
https://www.psychiatrist.com/jcp/oral-ketamine-for-depression/

In order to prescribe ketamine I have to take additional continuing education and certification. So, I don't have that yet, but I expect towards the end of the year, or the beginning of 2024, this will be one more treatment I can offer patients.

​a note on billing codes, and when more than one code is used for one visit

​If your visits with me are not billed to your insurance plan, you can just go ahead and skip this fairly dry subject.

For the rest of you, I wanted to take a moment to describe how and when I use what codes. I hope that no one's eyes glaze over in boredom, but I feel that I'm the best to discuss this subject because when insurance billing questions come up, it is usually our office manager Iris who handles this. And Iris is great, we all love Iris, however she is not present during the visits, so she just has to guess why and how I'm using the various codes that I do.

A common category is called an extended time code.

The best way I can describe this, is think back to the last visit you had with a "standard" medical provider for your concern (pain, hormones, diabetes, thyroid, GI, you name it).

How long was that visit?
How many other conditions did you discuss and make a plan for that day?

If your provider was following typical norms, the average appointment time is 5-7 minutes, and is focused just on that one concern.

If you bring up another concern, the provider often will tell you that you have to book a separate visit to address that second concern.

Now compare that to a typical office visit with me, which lasts 30-60 minutes. I am often working up many concerns at once (your chronic joint pain, your allergies, your hormone deficiency, reviewing your blood sugar labs, and what is this weird new thing on my skin???).

With how codes are set up, I'm not going to bill four office visit codes just because I cover four of your concerns (and that's a very low estimate for what's typical in my visits).

Instead, I will bill an office visit code with an extended time code.

The first code tells your insurance company we had a medical visit. The second code tells them we went into a lot of depth above and beyond typical office visits.

Other types of codes I use, in addition to office visit codes, are:

• Injection therapy codes (prolotherapy, trigger point injections, PRP). That's pretty self-explanatory.

 

• Other in-office procedures, such as blood draws, hormone pellet insertion and biopsies.

 

• Alpha Stim sessions, as mentioned above.

 

• Physical rehab and treatment codes: these cover hands-on care (such as myofascial release, exercise rehabilitation, joint manipulation) and other services, such as fitting braces and orthotics. I don't bill them too often, as usually with these patients there is a massage therapist, chiropractor, physical therapist, etc., also helping them out, but occasionally it does come up.

​

​ok, that's enough updates for now

I hope you have a lovely fall, and can enjoy our entry to the cozy, warm, hibernation season. I've been enjoying breaking out my herbal tea blends again, and snuggling up under blankets with a good book.

I wish you the very best in feasting, friends, family, loved ones, or any other seasonal quality time you enjoy,
Dr. Angela Cortal

​