Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1165
Narratives 91 N

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very 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 more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"When to report initial vs. final diagnosis"


Guest Doctor: when we see initially a personal injury patient, we do the evaluation, we do the necessary x-rays, then we give them a diagnosis as a courtesy to the attorney. We send a first report outlining all that. Then as the patient goes through the treatment plan, we do our evaluations every 30 days and drop or add diagnosis as necessary. Now when we get to the end of the treatment plan, we do our final narrative.

Dr Studin: there is no such thing as final. You do your narrative, just in case, you don't want to perjure yourself.

Guest Doctor: On a prior conversation with you, you said only the diagnosis that are applicable at the time of that evaluation go on the narrative.

Dr Studin: This are two separate issues. You can have initial diagnoses and you can have final diagnoses. You can have those two things there to show How it progressed.

Guest Doctor: on a narrative?

Dr Studin: Yes, on the narrative. You can do that. Not An E&M report, but in narrative you can. initial diagnoses, data, whatever the original date was and current diagnosis and E&M report, you only put current diagnoses, but narrative it's called and you need to take the testifying part two course called forensic documentation and you will learn a phrase called the four corners of a report, And in a four corners report you need to come to the four corners of the case, which includes what happened in the beginning, in the end.

Guest Doctor: well that answered my question because my question was going to be if we just put the diagnosis that's applicable, when we're doing the narrative, then how does the attorney know that they had maybe a concussion that was dropped before,

Dr Studin: also remember and that's part of your answer, but the other part is the lawyers should be looking at the ENM report. That’s number one. But number two, if the concussion got better, what difference is a matter to transient issue? So, if they're going to shoot the pain and suffering versus what is persisted after reasonable course of care is concluded. Those are two very separate issues.

Guest Doctor: My other question was going to be is this, we have in California has something called Med pay, I got a denial from USAA that none of the treatment was necessarily.

Dr Studin: USAA is the biggest aggressive right now in the country. They are really upside down, the issue is that's absurd. Now the question is, and that denial was that based upon a peer review and IME or just the claims rep?

Guest Doctor: It was a DC who quoted several different sources that none of this is necessary.

Dr Studin: So what you need to do is unique, it was a paper review. So that's where you need to hire a Dr Maloney and let him write the rebuttal for you. Fill up all the other sources and you need to set precedent because that's absurd, here's the issue. Did the guy comments on your positive findings or no?

Guest Doctor: I don't think so.

Dr Studin: So therefore, he committed licensure violation, fraud. He ignores all of those things. And lying by leaving stuff out It's just as bad as lying by putting extra stuff in that doesn't exist as option. With that being said though, both of them are lying and that's fraud. The lawyer is going to have to pull up the statutes in California of showing how to have to license your violation and render a complaint against this guy. Then write a report to USAA saying the guy lied. Licensures complaint going against them. If you do not reverse your position on this and pay immediately, then we'll consider you complicit with this lying and reports you to the attorney general state of California for being complacent. Get them all that and get it done. People underutilizing it, you have to do that because your reputation is at stake. Your reputation, evidence-based providers doing good work. All of a sudden they're saying you'll also the crap. 

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