The home health agency where I work has instituted a new program for anodyne therapy and is encouraging all of us on the rehab team to include this modality in our care plans when appropriate. We have been in-serviced by a manufacturer’s rep from the firm that sold the anodyne units to our agency for use with patients. What is your experience with anodyne, and what is the Medicare view of it as a pain relief modality?

     Good question. First, we’ll define and discuss anodyne and its historical use as a therapeutic modality. Secondly, we will examine its role in the realm of Medicare certified home health to determine appropriate utilization as a treatment modality. 

      The product currently promoted as anodyne therapy is, in fact, infrared therapy. This low-level infrared light treatment is classified as a form of superficial heat and has been used as a physical therapy modality for over 40 years. It provides a level of heat comparable to other superficial delivery methods such as moist heat, paraffin, or warm whirlpools. The term “superficial” refers to the application of the modality to the skin surface in order to heat the skin with limited effects on the underlying deep tissues. This lack of depth penetration of the heat itself is a direct result of the circulatory response that increases local blood supply to the warmed area as a defense against burns. This physiological response is identical to that seen with topical heat creams, such as Ben-gay. Benefits expected from superficial heat include a general analgesia, alteration of the pain-spasm cycle, and increased local metabolic activity (as discussed). Heat penetration is generally no deeper than 1 cm. Any characterization or discussion of anodyne must relate to its’ status as a superficial heat modality. 

      In contrast, heat modalities that are generally recognized as more effective are forms of “deep heat”. A few examples are ultrasound, shortwave, and microwave diathermy. These forms of heat use high frequency currents (shortwave), high frequency sound waves (ultrasound), or electro-magnetic radiation (microwave), to deliver heat to the application area without raising the skin surface temperature. Expected levels of deep heat penetration can be up to 5 cm. The clinical benefits of deep heat are well documented and have significant historical profiles as effective forms of physical therapy. 

      Medicare policies regarding the use of heat modalities in skilled physical therapy programs have certainly evolved over the past 25 years. Whereas superficial heat treatments were once considered skilled therapy, general CMS definitions have declared this form of treatment as not individually and directly reimbursable as physical therapy for over a decade. In fact, the use of these modalities in sub-acute and outpatient therapy is un-billable to Medicare. Any utilization of superficial heat must be combined with a skilled form of treatment, therex or gait training, for use in either of these types of departments. 

     Now, to answer your question, we will extrapolate these superficial heat realities onto the current Medicare home health model. The use of anodyne (superficial heat) by itself is not a physical therapy modality. However, the comprehensive billing system introduced during the initial PPS reform does not relate payment directly to specific modalities included in the plan of care. Therefore, anodyne, or any other form of superficial heat, may be used in conjunction with other skilled PT treatments. It is important for Medicare certified agencies to note that any positive results from the use of anodyne must relate to functional improvement. If function or safety deficits are directly related to uncontrolled pain, anodyne may well be the appropriate modality of choice to precede strength or safety training. Clinicians must be vigilant to document positive results of anodyne treatments in terms of improved function rather than subjective pain improvements. If ambulation or functional strength is compromised by pain, anodyne treatments that relieve the pre-existing pain and therefore allow gains in function and safety are certainly appropriate. 

      The recent popularity of anodyne in the home health arena prompts the concerns that some of the realities listed above are generally unknown to those involved. Well-meaning agencies, home health administrators, marketers and physicians should remain knowledgeable regarding how anodyne works and its appropriate use in home health.            

Teri N. Thompson and Arnie Cisneros are physical therapists with nearly 40 years of combined home care experience. Co-owners of Home Health Strategic Management in East Lansing, MI, they provide clinical service management and home care consulting expertise. They are nationally renowned speakers regarding the PPS refinements of 2008 and therapy utilization under the New Rule.