Phase Angle

Phase angle results of Eddie Griffiths

Basal Metabolic Rate (BMR) K Calories

Basal Metabolic Rate (BMR) results of Eddie Griffiths

Body Mass Index (BMI)

BMI results of Eddie Griffiths

Parallel Capacitance (pico farads)

Parallel capacitance results of Eddie Griffiths

   [  ] 93720 Plethysmography, total body, interpretation and report.
   [  ] 93721 Without interpretation and report.
   [  ] 93722 Interpretation and report only.

ICD-9-CM Diagnostic Code                       Diagnosis

_________________________   __________________________________________________

Signature : _______________________________________  Date : _____________________

Physician : _____________________________  Examiner : ___________________________

Body composition analysis is often reimbursable in clinical settings. Although there is no specific CPT (current procedure terminology) code for body composition assessment, it can be covered under established codes for general office visits and patient evaluations. Ultimately, reimbursement depends on the policies of each insurance carrier. If the test is performed by a doctor, nurse, nurse practitioner, or physicians assistant, codes for office exams can be used (example, CPT codes 99212 and 99213 for an established patient). Dieticians and other specialists would use their standard visit codes. If the test is done by a technician, use a miscellaneous code such as 97750 (physical performance testing and measurement). Usually, health care providers test body composition as a part of patient evaluations and consultations. Providers recover additional costs by upgrading the reimbursement claim to reflect additional time spent. For example, upgrading an established patient exam from CPT code 99212 (evaluation and management of established patient - self-limited problem - 10 minutes) to 99213 (evaluation and management of established patient - problem of low to moderate severity - 15 minutes) generally increases reimbursement by about $10 - which is reasonable based on equipment, supplies, and time used for a body composition test. Many practitioners perform body composition analysis as a part of diagnosis or treatment for a specific medical condition. For example, if a subject has been diagnosed with a weight-related health condition such as diabetes or hypothyroidism, the body composition test may be reimbursed under categories related to that condition.

Phase angle is based on total body resistance and reactance and is independent of height, weight and body fat. Lower phase angles appear to be consistent with either cell death or a breakdown of the cell membrane. Higher phase angles appear to be consistent large quantities of intact cell membranes and body cell mass. All living substances have a phase angle, in fresh uncooked vegetables phase angle can exceed 45 degrees. In cooked vegetables phase angle is zero because they are dead.

Phase Angle is a predictor of outcome and indicates the course of disease or increases as the result of optimal health based on good nutrition and consistent exercise.

As we get older our phase angle will decrease and will be approximately 4 or less when we die. Fit adolescents may have a phase angle greater than 10. This effect is a result of cell integrity due to age. Low phase angles are consistent with:

1. Malnutrition
2. HIV/AIDS infection
3. Cancer (most types)
4. Abusive life style
5. Chronic Alcoholism
6. Old Age (80 - 100 years)

Good fitness and life style is the key to maintaining a healthy phase angle.

Phase angle is good indicator of disease progression although it is not used to diagnose a specific disease. It may be thought of as a thermometer with a broad range of normal. It may also be used to monitor the practice of good health, which would include healthy diets, the use nutritional supplements and exercise.

References:

Energy is the most fundamental need of biological systems. Without it, the basic biological processes of life cannot occur. Survival depends on consistently finding the right fuel in the appropriate quantity to sustain the biochemical reactions of energy metabolism. The body extracts and uses energy through the process of metabolism. Metabolism occurs in two distinct and interdependent phases: 1.) catabolism, in which the body breaks down food into its component parts and harvests the energy stored in its atomic bonds, and 2.) anabolism, in which those component parts and energy are used to build new tissues and conduct basic life functions. Basal Metabolic Rate (BMR) is the amount of energy your body requires every day to perform its most basic function including:

1. Breathing
2. Digesting
3. Heart beating
4. Muscle activity
5. Transportation of fluids and tissue
6. Circulation of blood

BMR is the only a way to estimate how fast you burn calories. The slower your metabolism, the more weight you will retain. If you burn your daily calorie intake, you will maintain your current weight. Burning more than your daily intake, causes weight loss. There are many factors that vary your metabolism. However, exercise and daily activity level are key to increasing your BMR. There can be major nutritional consequences to the decline of the BMR in advanced age. Decreased caloric requirements may lead to decreased food intake. Sufficiently low caloric intake can lead to deficient intake of essential nutrients.

BMR varies between the sexes. Lean body mass is a major determinant, and women tend to have less lean muscle mass. As a result, their BMR is lower than that of otherwise comparable males. BMR is at peak during infancy, then it declines rapidly through childhood and adolescence. It continues to fall slowly with increasing age and decline further with old age largely due to a loss of muscle mass. However, this is not inevitable, because weight-bearing (resistance) exercise will prevent or reverse muscle loss among the elderly.

BMI stands for "Body Mass Index," a ratio between weight and height. It is a mathematical formula that correlates somewhat with body fat.

If your BMI is high, you may have an increased risk of developing certain diseases, including:

1. Hypertension
2. Cardiovascular Disease
3. Dyslipidemia
4. Adult-Onset Diabetes (Type II)
5. Sleep Apnea
6. Osteoarthritis
7. Female Infertility

Prevention of further weight gain is important and weight reduction is desirable.

BMI is a better predictor of disease risk than body weight alone. However, there are certain people who should not use BMI as the basis for estimating body fat content: competitive athletes and body builders, whose BMI is high due to a relatively larger amount of muscle, and women who are pregnant or lactating. Nor is it intended for use in growing children or in frail and sedentary elderly individuals.

All living things are made of cells. Cells are membrane bounded compartments filled with a concentrated solution of chemicals and salts. Groups of cells perform specialized functions and are linked by an intricate communications system. The cell membrane maintains an ion concentration gradient between the intracellular and extracellular spaces. This gradient creates an electrical potential difference across the membrane which is essential to cell survival. Electrical gradients are necessary to support movement of oxygen, carbon dioxide, and nutrients. Therefore, the cell membrane has electrically insulating qualities or capacitance.

Electrical capacitance will increase or decrease depending on the health and the number of cells. Damage to the cell membrane, and its functions, is as lethal to the cell as direct damage to the nucleus itself. ";

The cell membrane functions as a permeable barrier separating the intracellular (cytoplasm) and extracellular components. The lipid membrane is transversed by proteins, which are soluble in water thus making pores through which water, ions and other chemicals can enter and exit the cell.

BIA prediction equations have been developed that use parallel resistance and reactance as predictors of extracellular mass and body cell mass. Comparisons to K40, DEXA and D20 were very good (r > .9) and are sufficient to be used in clinical practice and studies of wasting disorders in AIDS patients.[1]

Parallel capacitance is somewhat like phase angle, whereas it is not effected by weight or body fat. It is a measure of cell membrane health in all living substances and can change dramatically depending on disease or good health.

A body builder, for example, would have a high parallel capacitance and low resistance, or more cell volume, because he is extremely muscular and fit. A malnourished AIDS patient would have a low parallel capacitance.

References:

Scale weight is not an indicator of an individuals fat, lean or health. Body composition is the amount of lean tissue compared to fat. Body composition data can form the basis for a wide variety of therapeutic health and fitness prescriptions. In clinical applications body composition analysis along with nonpharmacologic nutrition and exercise prescriptions provide the foundation upon which further treatment is based. Only body composition analysis can determine how much muscle and fat are lost or gained as the result of any nutrition, exercise, or pharmaceutical prescription.

How is abnormal body composition managed?

	The energy storage compartment, Fat Mass	Fat is the energy storage mass of the body and is the total lipid mass (triglycerides) with a density of .9 g/ml. Fat mass is equal to actual weight minus fat free mass
	The functional compartment, Body Cell Mass	BCM is the functional mass of the body where work is done. All oxygen consumption, carbon dioxide production, glucose oxidation, protein synthesis and other metabolic work takes place within the body cell mass. The body cell mass is, in effect, the total mass of all the cellular elements in the body, and therefore, represents the metabolically active component of the body. In the normally nourished individual, muscle tissue accounts for approximately 60% of the body cell mass, organ tissue for 20% of body cell mass, with the remaining 20% made up of red cells and tissue cells. It also contains the majority of the body's potassium, (98 - 99%).
	The support compartment, Extracellular Mass	ECM is the support mass of the body and is metabolically inactive, consumes no oxygen, produces no carbon dioxide and performs no work. The extracellular mass consists of extracellular fluids and solids, such as bone and cartilage, with its primary function that of support and transport. ECM is located outside of the cellular compartment or outside of the body cell mass. Lean body mass is the sum of body cell mass and extracellular mass.

What are the long-term benefits of a good body composition prescription?