Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 57

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.

"Compliance Alert: Treatment Orders"

To adjust a patient is a very easy task. To get paid on that patient is also relatively easy. To keep your money at the end of the day can sometimes be a daunting task.


Upon compliance review, the first place an auditor looks is your treatment orders. Was the treatment plan ordered? Were the x-rays ordered? Were nutritional supplements ordered? The list goes on.


This is a very simple, yet often overlooked task. The treatment plan has to be clinically indicated based upon the results of a comprehensive evaluation and management encounter. Once implemented, the SOAP notes have to match the treatment plans and there has to be a periodic re-evaluation. If this seems complicated, go back to your chiropractic training, as we were all taught this very basic paradigm. It hasn’t changed in 30 years, as that is when I was taught and I do not consider myself to be better trained than anyone else. Perhaps just the opposite!


I have looked at all of the audits I have done over the years for doctors who had to defend themselves. It always came down to the necessity of the treatment plan and the documentation of the implementation of that plan. This is not rocket-science.


Do you have a recommendation for treating the thoracic spine or do you consider that nonsense because the cervical spine is attached to the thoracic spine in a transitional area, so you believe you do not have to document findings of the thoracic spine and therefore can bill a higher code for 3-4 areas instead of 1-2 areas? That doesn’t bode well once the microscopes come out. In fact, that is one of the first issues that trigger an audit and will be the reason for you to fail in the defense of your records.


Do you have treatment orders for:


  1. Every region/area adjusted


  1. All modalities utilized


  1. Change in frequency between evaluation orders


  1. Change in duration between evaluation orders


  1. Supports


  1. Supplements


  1. MRI’s


  1. Bone Scans


  1. X-Rays


  1. Home exercises


  1. Outside referrals


A treatment order is usually ordered in a formal evaluation. However, you may modify that order in a SOAP note under the “P” or Plan. This is a valid and time saving avenue for modifying your order. Using a template SOAP note or an electronic note, as long as it is customized, are compliant avenues to ensure that you have met every documentation requirement.


P.S. Never use a travel card.


P.P.S. Get a compliance audit from Dr. Schonfeld at 516-695-7732.

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