Chiropractic Coding & Compliance Alert

Reader Questions:

Check With Your LCDs Before You Give Dynamic Thrust

Published on Mon Aug 10, 2015

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Question: A patient presents with low back pain, and he also reports to be on anticoagulant therapy. The DC examines him and feels that the patient would benefit from CMT, chiropractic manipulative treatment. However, is there any CMS guideline that we need to be aware of while deciding on the treatment, given the fact that patient is on anticoagulants?

Mississippi Subscriber

Answer: As you may know, CMT requires that the provider perform a dynamic thrust to the treatment area. According to CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 240.1.3B, “Dynamic thrust is the therapeutic force or maneuver delivered by the physician during manipulation in the anatomic region of involvement. A relative contraindication is a condition that adds significant risk of injury to the patient from dynamic thrust, but does not rule out the use of dynamic thrust. The doctor should discuss this risk with the patient and record this in the chart.”

Bleeding disorder and anticoagulant therapy are listed as one of the relative contraindications, so you need to be careful, find alternative methods of treatment if you can, and still if you decide that the benefits of the treatment far outweigh the distant potential risk, you should proceed only after discussing all this and other treatment options, and obtaining patient’s informed consent for the same.

For further list of contraindications pertaining to dynamic thrust, check with your LCDs.