Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 993
Office Systems 79 OS
“Get Paid on Long-Term Care: Detailed”
“I am willing to outwork EVERYONE… That is my secret to my success” Mark Studin 2018
In quickie consultation 990, located in the office systems and getting paid section #57 L, I discussed “treatment goals and getting paid for long-term chiropractic care.” In that section, I introduced the concept of utilizing biomechanical pathology versus pain as a goal for care and a demonstrable piece of evidence to show the progression of care during the reconstructive phase. This consultation is centered on how to integrate the treatment of biomechanical pathology into the totality of the case, inclusive of documentation in the medical-legal environment (narrative).
This concept has been detailed visually for you in primary spine care #6 that will be presented live on October 27 and 28, 2018 in New York (click here to sign up) and if you are reading this after that date, it can be found at www.teachdoctors.com. This is a concept that needs to be fully understood because it integrates many disparate pieces of information in the literature and must be combined to render a complete diagnostic, biomechanical, impairment, connective tissue and functional loss conclusion. This concept goes well beyond the Colossus paradigm and resolves every issue a court could have in determining causality, bodily injury and persistent functional loss.
Moreso, it resolves the carriers algorithm of reimbursable encounters because it is based upon pathology versus wellness, maintenance, reconstruction or any other label that the carrier can utilize to limit reimbursement. Please note that unless you have the requisite credentials behind you, it will be more of an uphill battle to ensure payment. The minimum required credentials are spinal biomechanical engineering, spinal trauma pathology, and spinal disc and ligament neurology and pathology. Those courses are co-credentialed through both chiropractic and medical academia and will give you the background knowledge to both documents and argue from a verified expert position the necessity to treat this specific pathology.
In a previous consultation, I documented the following:
“It has been well-established that ligament pathology, no matter how small or large affects spinal biomechanics, with more significant damage leading to quicker spinal instability and degeneration (Wolff’s Law). The above is the arbiter to demonstratively show the progression of care and the realization of goals.”
This is only the beginning of showing biomechanical failure. When you are looking to document spinal failure, I refer back to the work of Dr. Wiegand. In his computer algorithm, he can numerically quantify “stress units” which show a lack of organization of the spine and points to primary versus compensatory lesions. It is in those well-documented stress units and lack of organization that you demonstrably show the biomechanical pathology. In that report, there should be an explanation that can be a macro that outlines the literature-based evidence of how far vertebrate can move out of its normal juxtaposition to determine that there is an ongoing pathology. The next step is to explain Wolff’s Law, which again should be done through macros if there is already remodeling of the motor units. Also, should there not be any degeneration at that level, we then explain how collagen and elastin are replaced with only collagen and depending upon the severity of the biomechanical pathology will then enable us to prognose both short-term and long-term care with associated goals.
As you treat, you will be able to re-x-ray the patient (again, knowing that diagnostic x-ray has no cumulative or pathological sequela as per the literature) to show the progression of care through comparing either global stress units or individual motor units, which can be done visually (demonstrably). When the spine is stabilized or reaches MMI (maximum medical improvement), you can then render an impairment rating based upon the AMA guides to realize the full AOMSI impairment or prorated down to the 1mm deviation allowed in the literature.
Your treatment should be predicated on biomechanical failure and subsequent reintegration with verifiable parameters that are easily demonstrable. The challenge is to make this understandable to the layperson. However, my challenge is first to get you to fully understand and utilize it in your everyday practice so you can realize fair and equitable reimbursement for necessary care and not be held to goals that are purely based and pain scales.
Never lose sight that pain is the first to go in treatment and underlying biomechanical failure or pathology cannot be corrected until the pain goes away. The reason; pain is often associated with muscle spasticity, and those muscles are holding the motor units in a pathological location. Also, the “plica” or little discs between the facets are malpositioned and creating nociceptive reactions that create neural plastic changes to compensate for that pathology. CLICK HERE FOR A RESEARCH ARTICLE TO EXPLAIN THE ABOVE PARAGRAPH
This is quite easy to understand when you have all the pieces, and the tools to both explain and report this pathological phenomena. I will be explaining this in intimate detail during the primary spine care 6 symposium. I urge you to either be there to learn how to get paid or take the online course which will not be available until early 2019.
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
Academy of Chiropractic
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