Requirements to Report Chiropractic Visits
by Marty Kotlar, DC, CPCO
The Social Security Act (§30.1.) defines a chiropractor as a physician whose scope of practice is limited to manual manipulation or treatment of subluxation of the spine (subluxation may be demonstrated either by X-ray or physical examination).
To support a Medicare patient’s initial visit, the chiropractor must document eight items in the clinical record on the initial visit, per the American Chiropractic Association (ACA):
- A chief complaint must be documented, including the symptoms present that caused the patient to seek chiropractic treatment
- History of present illness, to include (as appropriate):
- Mechanism of trauma
- Quality and character of problem/symptoms
- Intensity of symptoms
- Frequency of symptoms occurring
- Location and radiation of symptoms
- Onset of symptoms
- Duration of symptoms
- Aggravating or relieving factors of symptoms
- Prior interventions, treatments, including medications
- Secondary complaints
- Symptoms causing patient to seek treatment
- Family history
- Personal health history, to include:
- General health statement
- Prior illness(es)
- Surgical history
- Prior injuries or traumas, past hospitalizations (as appropriate)
- Physical examination/evaluation of musculoskeletal/nervous system to identify:
- P = Pain/tenderness evaluated in terms of location, quality and intensity;
- A = Asymmetry/misalignment identified on a sectional or segmental level;
- R = Range of motion abnormality (changes in active, passive and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); and
- T = Tissue, tone changes in the characteristics of contiguous or associated soft tissues, including skin, fascia, muscle and ligament.
To demonstrate a subluxation based on physical examination, two of the four criteria mentioned above are required, one of which must be asymmetry/misalignment or range of motion abnormality.
A patient’s subluxation/condition is considered to be chronic when it is not expected to resolve completely, but where the continued therapy can be expected to result in some functional improvement. Coverage will be denied if there is not a reasonable expectation that the continuation of treatment would result in improvement of the patient’s condition. Continued, repetitive treatment without a clearly defined clinical end point is considered to be maintenance therapy, and is not covered.
Complete requirements for chiropractic services under Medicare may be found in the Medicare Benefit Policy Manual, chapter 15, §240, “Chiropractic Services.” Be sure to read your local Medicare carriers guidelines for chiropractic services, also.
- The diagnosis: Most Medicare carriers require the primary diagnosis to be subluxation and the neuromusculoskeletal condition necessitating the treatment to be listed as the secondary diagnosis.
- The treatment plan, which should include:
- Therapeutic modalities to effect cure or relief (patient education and exercise training)
- The level of care that is recommended (the duration and frequency of visits)
- Specific goals that are to be achieved with treatment
- The objective measures that will be used to evaluate the effectiveness of treatment
- Date of initial treatment
- A signature/initials to authenticate the records.
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