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May, 2013

Are Your Practice Protocols Up to Date?

By William Wetmore, DC

Are you continuously updating your capabilities in an effort to provide medically necessary treatment and rehabilitation services? If you want to get paid, it would be very wise to do so NOW.

Case Management

How are you managing cases? When we buy something online, we can track it and always know where it is. Well, that's how your patient case management should work. Does it?

A good patient case management policy will have a significant impact on your bottom line. When you do an online order, the package proceeds from point A to point B, and it is all choreographed to get your package to you via the best route in the shortest amount of time.

practice protocols - Copyright – Stock Photo / Register Mark That is the perfect blueprint for a good patient case management program. Implement a program where you can plot, and track your patient's progress (outcomes) throughout their entire treatment plan.

Here are the categories in a patient case management plan. Problem Focused Exam – Imaging (if necessary) – Diagnostic Testing – Treatment Plan (Acute care protocols, Rehabilitation protocols, Progress exams, Follow-up diagnostic testing to establish outcomes and the need for continued care, ADLs, Exacerbations, Update diagnosis as patient improves, etc.

All this information can fit nicely on a one page form, and it should be the first page in every patient file. It will be a constant reminder as to what your patient needs, and when the need it. So, when a patient needs a re-exam or follow-up diagnostic testing, etc., have the patient tell the front desk to schedule the procedure on their next visit (or notify the front desk yourself). Remember, technology rules progress, and the public is addicted to technology.

Technology

Sadly, I see providers spending tens of thousands dollars on the "wrong stuff," equipment that does not enhance their ability to document medical necessity and does not provide access to extended medically necessary treatment, and most critically, is often results in cases being ineligible for reimbursement because the trendy software and hardware does not result in the documentation of medical necessity or positive outcomes.

There are many advanced coding and documentation options available to chiropractors that are compliant with the chiropractic scope of practice, but we have allowed outside entities to mislead us into using the limited and confining CMT codes. The CMT codes require the documentation of nine components for each region. Think about that for a moment and review your CMT documentation to see how many components you have actually documented.

I am a subcontractor to a national law firm as an expert in coding and documentation. They hire me to review the insurance company's audits of the DC's coding and billing practices. The CMT codes factor into every insurance audit. And in a recent audit, the insurance company is demanding the return of $137,000 for "overpayment" of the CMT codes due to the lack of adequate subjective and objective documentation.

Here is just one example of a coding option: Most chiropractors use Trigger Point Therapy as part of their treatment protocols. And most don't even bill for it. But when they do, they bill procedure code 97140 Manual Therapy Techniques. THIS IS WRONG and it will raise the audit flag.

As a Provider Compliance Consultant, I represent chiropractors who are or who have been audited. And I can tell you that 90% of audits are based the following: CMT code 97140 and the lack of diagnostic testing that documents medical necessity with objective findings of functional impairment and positive outcomes.

Now, here's what is wrong with using Trigger Point Therapy as a treatment procedure. First of all, Trigger Point Therapy is a technique, not a treatment procedure represented by a billable CPT code. The appropriate procedure representing the Trigger Point Therapy technique is "Ischemic Compression," which should be billed as Massage 97124 (effleurage, petrissage, tapotement, stroking, compression, percussion).

The following is critical: When performing the 97124 massage procedure on the same day as a CMT procedure, the 97124 massage procedure must be performed on a separate region than the CMT procedure, and the -59 modifier must be used to identify the massage procedure is being performed on a separate region, and should be billed as 97124-59 massage (compression). And your documentation should specifically name the muscle(s) being treated.

CAUTIONARY NOTE: If the muscle(s) being treated attach to the region where the CMT was performed, they are considered as part of the CMT region and the massage procedure cannot be billed separately.

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