Wiki Closed fracture care by chiropractor

[betsycpcp]

Does anyone know if chiropractors (in this case a chiropractic orthopedist) can bill closed fracture care codes such as 26600 (closed treatment of metacarpal fracture without manipulation)? A chiropractor is claiming she can bill for this because of her chiropractic orthopedist credential. She says she's licensed and certified to treat fractures.

This is in Ohio - it may vary from one state to the other, but I'm wondering if this is paid anywhere. The Bureau of Workers' Comp denied it saying the procedure isn't valid for that provider type. She may appeal it, but I'm wondering if anyone has seen these paid or has billed it.

Thanks for any help.

 

[dchenkin]

Scope of practice is defined by a state's laws and regulations. I did some basic research into Ohio's laws and regs regarding the practice of chiropractic (I am a paralegal by profession). From what I found it appears that Ohio does not recognize the title of chiropractor orthopedist. According to section 4734.15 of the revised Ohio code, chiro's cannot perform surgery. Is a closed reduction considered "surgery" in Ohio? Furthermore, section 4734.01 appears to limit the practice to "specific vertebral adjustment and manipulation of the articulations and adjacent tissues of the body".

This seems to indicate that the chiropractor acted outside of state law. However, only a lawyer would be able to provide a more accurate answer. Hope this helps.

 

[betsycpcp]

Thanks for the research--unfortunately I can't find anything that would tell me if the state would consider closed reduction to be surgery. Since the Bureau of Workers' Comp denied the code stating it's not appropriate for the provider type, I believe the provider will have to either rebill with E/M codes for the individual visits, or take it up with the BWC and see if she can persuade them. I've been dealing with workers' comp for 17 years and I've never run across a chiropractor trying to use a closed fracture treatment code before.

 

[dchenkin]

As a quick aside, in your original post you did say that the treatment would be without manipulation so the use of a closed reduction by way of example was not entirely appropriate. But I think the key is that other than being able to provide acup treatments, if properly certified, it seems in Ohio a chiro is limited to treating the spine and adjacent joints and muscles. Again she would need to consult with local counsel who would know the real ins and outs of Ohio law.

Additionally, this may provide an opportunity for the chiropractic community to petition the chiro board to broaden its definitions regarding scope of practice.

 

[betsycpcp]

ORC 4734.01 also mentions "rehabilitative procedures" as part of the definition of chiropractic, so it's not as narrow as it sounds. Under the scope of practice section it says they can't treat infectious disease or do surgery and a few other things, but it's vague on what they CAN do. They routinely bill and get paid for physical medicine codes, x-rays and E/M codes.
If she's adamant about using 26600 she'll have to argue it with the BWC, but since she has the option to bill E/M codes maybe she'll just do that.
Thanks for your input.