The Post-Surgical Client Who Wants 'Just a Little' Work
A 62-year-old man calls to book a massage 10 days after knee replacement surgery. He says his surgeon told him 'massage is fine' but he has no written order, and he is still on prescription anticoagulants. He wants you to work directly over the incision and the surrounding swollen knee, and he wants you to 'push through' the stiffness so he can stop using his walker sooner. He also asks whether you can bill his insurance for 'medical massage' and whether you need to keep records, since he's paying cash.
1. Can you treat the knee as requested? What conditions would you set?
Read the worked answer
Not as requested. Ten days post-op with swelling and anticoagulation means direct work over the incision and deep pressure on the knee are contraindicated - risk of bleeding, dehiscence, and interference with healing. A verbal 'massage is fine' is not a written release, and you should obtain written clearance from the surgeon before working near the surgical site. If clearance is obtained, you would work proximal and distal to the joint, avoid the incision, use gentle techniques, and coordinate with his physical therapy. 'Pushing through' stiffness is not your role; that is the PT's domain. Set conditions: written clearance, no direct incision work, light pressure, and stop if swelling or pain increases.
2. How do you answer his billing and record-keeping questions?
Read the worked answer
You explain that whether insurance covers massage depends on his plan and whether you are credentialed; 'medical massage' is not a billing code by itself, and you should not promise coverage. You do not submit claims you cannot support. On records: cash payment does not eliminate documentation. You keep a treatment record - intake, consent, findings, techniques, and any referrals - for legal, clinical, and professional reasons, and you explain that this protects him too. You do not share records without authorization except as required by law.