Academy of Chiropractic Personal Injury & Primary Spine Care Program
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“Top 10 Narrative Issues”
A compilation of Dr. Schonfeld’s findings and why Wall Street is enamored with this process…It is called OVERSIGHT!
“I can never be bored...there is too much to learn” Mark Studin 2018
From the desk of Michael Schonfeld DC, DABCO
After spending the last four years writing thousands of narrative reports I have come up with ten essential items that need improvement. They are listed below not in any specific order:
Too Much Detail
[I.E.] Mrs. Irene Smith was the driver of the 1968 Volkswagen beetle who was restrained by a lap belt only because in 1968 shoulder harnesses were not available. Airbags did not also deploy because they were not available when she was struck head-on by a dark green minibus or minivan of unknown make on a dark and dreary highway that was misty as well as slimy… At the hospital, she rested comfortably and was released with home care instructions that included… Not that. She suffered injuries to her neck, shoulders, middle back, lower back, left hand, right hand, including those who bilateral pinkies,…… Before coming to my office, she saw the following six doctors….
Not Enough Detail
Mrs. Irene Smith was struck head-on by another vehicle.
2.INITIAL GAP IN CARE
If the patient went to the hospital via ambulance immediately after the crash and was seen by an orthopedist, neurologist and had physical therapy and then came to your office there really was not a gap in care.
A gap in care is when the patient either sees no health care practitioner for a few days after the crash. The key is why did the patient wait 2, 3, 6-12 weeks to come into your office even though they were in pain? Did a way to find an attorney to take the case or to make a case before they came in?
It is way too common to see doctors not using any pain scale to quantify their patient’s pain. Also, you must be clear on a VAS definition is it verbal analog scale that is using or visual analog scale? You must be accurate! Also, we recommend the 0-10 pain scale with 0 indicating the complete absence of pain and 10 indicating very severe pain. Moreover, finally, the pain scale could or should have range. In other words, the patient’s pain might not be the same all the time they could be of 4/10 when I wake up at an 8/10 at the end of a working day or vice versa.
One mistake is choosing an accurate diagnoses for the case in other words subluxation and sprain only versus the plethora of proper diagnoses available in the ICD 10 guidelines.
The other very common mistake is not updating your diagnosis after 135 office visits. If something hasn’t changed due to improvement/diagnostic studies/exacerbation you might be missing the boat
5. RANGES OF MOTION
Initial ROM were found to be virtually normal and the final ROM’s much worse despite the patient improving markedly and pretty much asymptomatic.
Also, if you’re still doing visual range of motion you should not use degrees when reporting them. By now all of you should using dual inclinometer’s so that you can record specific degrees & percent deficit’s
6. NON-EXISTENT DIAGNOSTIC STUDIES
There are so many cases that MRI, CT scan, EMG/NCV, etc. are indicated and not ordered that I see.
There are cases where MRI studies on negative while plain film x-rays reveal pathology and no x-ray digitization for AOSMI has been ordered. You may be missing the reason your patient is still symptomatic due to ligament laxity in the cervical or lumbar spine.
7. REVIEW OF SYSTEMS
If you choose to be the best of the best, review of systems is a necessity. Especially if your billing for code that requires it.
Very important, you cannot use boilerplate review of systems paragraphs. For example, I just did a report today where the patient had hypertension and reported an arrhythmia and diabetes, and the review of systems was essentially normal.
8. NO VITAL SIGNS
At a minimum, you should report the patient’s height, weight, pulse, blood pressure, and handedness. BMI, as well as pulse oxygenation, can also be included.
One of the problems I see is that six months a year two years later the numbers are the same, looks like a cut-and-paste job to me.
9. DERMATOMES/MUSCLE TESTING
Should be done on most of the accident cases we see, skipped over very often by ya’ll.
10. INCONSISTENT SPECIALISTS VERSUS CHIROPRACTORS FINDINGS
Too many times the radiologist report is inaccurate, you know that for a fact. By now you should be reading your own MRIs (after of course getting certified) and writing your own MRI reports and your own x-ray reports. Too often, the orthopedic evaluation indicates a different MRI finding that the radiologists are wrong.
You need to be the final arbiter on MRI findings, you are supposed to be the best of the best!
EVERYONE SHOULD BE USING Dr. Schonfeld’s service…It saves time and as Wall Street realized, oversight MAKES MORE MONEY!!!!! CLICK HERE TO LEARN MORE
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical 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
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