Academy of Chiropractic Personal Injury & Primary Spine Care Program

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From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues I bring are small, yet each issue is just that… an issue. If you take care of the small issues, then you will be able to build and focus on the larger issues… a larger, more profitable practice along with more family time. 

“Documenting Non-Pain Regions”

This is perhaps the most asked question on documentation; How do I document a non-painful region to be able to get reimbursed in a system skewed against chiropractic care? 

Many doctors feel they have been thrust into a pure medical model and cannot treat purely structural issues. The short answer is that you can, but in a medical musculoskeletal paradigm, reimbursement is tied into pain and functional losses. Therefore, you should relate the biomechanical failure to pain to ensure reimbursement if it is present. 

How do you do that when the patient does not report pain? The answer is “eliciting” a painful response. According to Dr. Frank Zolli, Professor of Orthopedics at the University of Bridgeport College of Chiropractic, it is consistent with current academic standards to palpate a paraspinal muscle and elicit a painful response. If present, you can then report that “the patient had an elicited tenderness at T7-9 on the right, with clinical findings of taut and spastic fibers at the same location” then include a diagnosis for the region (again, if clinically applicable). 

This resolves many documentation issues and allows you to treat the concurrent biomechanical failures and treat them as co-morbidities should they be present.



Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

Academy of Chiropractic
US Chiropractic Directory
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