Academy of Chiropractic’s Lawyers PI Program

Narrative #6

From the Desk of :

“Documenting Symptomatology In the Colossus and Court Environment”

Disclaimer: Colossus is a registered trademark of Computer Science Corporation and is used here for purpose of identification, description of comment. It is also used as the generic name for the myriad of programs used by various carriers.

When reporting symptomatology in the history, it is important to remember that both accuracy and complete details are critical. The standard of your license, as was taught to you in your professional training mandates that you document each symptom and then begin the process of determining the underlying pathology that is the etiology of that symptom. In personal injury, the legal phrase is documenting bodily injury and the legal community then needs to assign causality to that bodily injury. 

The carriers and the courts both have a very strong agendas in determining what specific bodily injuries have occurred as sequella to the trauma as both assign a dollar value to specific injuries. Various states have different methods of assigning a dollar value to the injuries based upon legal precedents and can inherently be altered with a judge’s decision. The carriers on the other hand, have a very specific algorithm to determine the value. It is that algorithm that we are going to dissect and although most of the main carriers have their own program to determine the value, for teaching purposes, I am going to simply lump them together and call them “Colossus.”

When considering that you are no longer dealing with human interaction, you must appreciate that the sole arbiter of both the frequency, type and duration of care allowed by the carriers along with the claim value for bodily injuries is purely dependent upon what and how you document. This level of documentation is the first opportunity you get to control the frequency, type and duration of care allowed by the carriers and it is 100% dependent upon your input. I don’t want to be Pollyanna-ish in stating that you fully control how much care is paid, however whatever could be allowed will be significantly reduced sugar documentation.

Remember, all information not included in the equation has no value. 

Colossus values are predetermined and in part the documentation of symptoms is part of the drivers that determine the value of a case. Personally, as a doctor I really could care less about how much a patient gets in settlement or verdict because my only focus is the creation of a diagnosis, prognosis and treatment plan followed by the successful treatment of my patient to bring them back to the pre-accident status. However, I concurrently have a responsibility to my patient to render a detailed, accurate and complete report that meets the standards of the courts, carriers, licensure boards and is consistent with what is being taught in academia today.

As I get further immersed in both the Colossus algorithms and academia by teaching in Chiropractic College at the University level I have come to realize that the carriers have got it right. The carriers demand in extreme level of specificity and detail documentation, which is exactly what is being taught in our academic institutions. Therefore my recommendation is to go back what you were taught during your doctoral training on documentation. Unfortunately too many doctors cut too many corners upon graduation and in the end it hurts both their practices and their patients.

When reporting symptomatology it is important to understand that the carriers claim representative scans your reports to answer questions Colossus is designed to ask. According to James Mathis, a former State Farm an Allstate representative that was integral in creating State Farm’s algorithm called “Teach” the following symptoms and value to the claims general range in the claim representative is trained to search for in the records. They are:

§     Range of motion

§     Stiffness

§     Headaches

§     Spasms

§     Dizziness

§     Visual Disturbance

§     Sleep Disruption

§     Radiating pain

§     Anxiety/Depression (also recognized as a possible symptom of neck/back injuries) This recorded symptom would allow for additional questions, which could add to the eneral damage value of the claim.

§     TMJ (also recognized as a possible symptom of neck/back injuries) This recorded symptom would allow for additional questions, which could add to the general damage value of the claim.

Should any of these symptoms be present they must be documented in the record accordingly. These symptoms give rise for additional input based upon duration and severity of each. As a result, when discussing the symptomatology with your patients be sure to include questions regarding any of the above.

Regarding anxiety/depression; in communication with numerous attorneys, specifically divorce lawyers and child advocate lawyers it would be advisable to not use symptoms or diagnosis of depression “loosely.” In a child custody hearing your record can become evidence against a parent be the cause for losing parental rights of their child by the courts. Therefore, I personally would lean on anxiety and/or present utilizes post-traumatic stress disorder (PTSD). In addition should a patient report they are depressed as a result of the trauma I would simply note that and referred immediately to a mental health professional.

Documenting duration of each symptom is critical in determining the impact that the accident had of your patient. During each encounter you have a patient you must document the persistence of the symptomatology accordingly in your SOAP note to accurately reflect the duration. Duration is a very important driver to Colossus and is equally important to licensure board should you ever need to defend your treatment plan. It is also expected for patients to have symptomatology that lessens over time once the patient stabilizes. This is where an accurate accounting through either a verbal or visual analog scale is utilized.

Carriers assigned stabilization periods for various injuries that range from one month to 36 months and it is based upon the reported injuries. Should you fall outside of their range it will trigger a warning that you are outside of the norm and potentially set an investigation by the carriers. However, if your records clearly indicate and reflect ongoing complaints and treatment with progressive improvement longer care will be accepted without triggering an investigation and added to the value of your patient case.

Your initial records set the tone for your entire case as a rule. Therefore a thorough evaluation must include all injured body parts. Documenting a symptom in one body part with pain radiating to a second body part precludes the claim representative from entering 2 injuries. As an example should you document neck pain with radiation into the right trapezius, right shoulder and the upper outer right arm according to the carriers constitutes only one injured body part, the cervical spine. Should there be a separate injury to either the trapezius, brachial plexus or shoulder that injury should be documented separately. Carriers assign a higher value to each individual injured body part and the region the pain radiates into is not considered a body part. In addition pain and inflammation are not considered injuries, they are considered as an effect to injury. Therefore if your diagnoses are limited to pain and swelling you have in fact not diagnosed any bodily injuries.

The symptomatology of the patient as taught in academia is the roadmap for both your clinical evaluation and any advanced testing indicated. As a busy practitioner I have often been guilty through the years as had not taking enough time to ask the right questions to ferret out each specific body part that could potentially have been injured. When a patient reported radiation of pain I often accepted that the space value and didn’t probe deeper as to the condition of the joint over which that pain radiated.

The Colossus equation is designed to establish general damages on top of the economic that. Therefore it is. Injury is input separately. As another example if the emergency room treating the patient for neck and shoulder problem and upon subsequent visit to your office the shoulder was neither commented on or diagnosis (according to Mr. Mathis) claims representative is barred from considering the shoulder as a separate injury. 

The Colossus equation structure as a flow sheet and each variable entered by the claim representative sets in motion an opportunity for additional variables to be considered. Multiple body parts being injured at considerable value to the case (when clinically present) this equation not be manipulated by the claim representative without your supporting documentation. The claims representative is allowed to sign as higher value to the case and as frequent care as is required without concern of negative backlash for their jobs provided your documentation needs Colossus algorithmic requirements.