Chiropractic Medicare Diagnosis (newsletter from 4/11/11)

April 11, 2011

Chiropractic Medicare Diagnosis

There are two factors involving the diagnosis of great importance. The diagnosis must be an honest diagnosis and that diagnosis must support the care rendered.

The first part of our Chiropractic diagnosis will always be a vertebral subluxation. It is our privilege and responsibility to determine the primary subluxation. Item 21, section #1 on the CMS-1500 form, will begin with the primary subluxation, either 739.1, 739.2, 739.3, 739.4 or 739.5.

After determining the primary subluxation, now you must determine the second part of the primary diagnosis. Since we are speaking about seniors over the age of 65, after doing x-rays (x-rays are mandatory each 12 months if the Chiropractor "proves" the subluxation by x-ray) the second diagnosis, since the subluxation has been present for the past 30 years, is degenerative joint disease. (You can see this condition on x-rays less than 12 months old.) This diagnosis goes in Item 21 section #2.

The third part of the diagnosis is usually why the patient came to your office. An exacerbation is any event, great or small, that has insulted pre-disposed soft tissue creating pain that the patient can place and exact time and date. Soft tissue in a predisposed degenerative joint has been insulted, stretched, torn, twisted and may be bleeding called sprain/strain.  That is the third part of the diagnosis entered into item 21 section #3.

The fourth part of item 21 will probably be your next important subluxation.

NOTE:  Each time there is a new exacerbation, date of current, item #14 is updated to date of exacerbation.