Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 269
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.
"Ordering Diagnostic Tests"
Yesterday, we had our seminar on becoming indispensible to the lawyer and it was a huge success. I will be posting within 2 weeks a video of the conference for all to review. One of the items discussed was ordering tests and a doctor requested that I create a quickie consult on how to do so. First, this was handled in detail in a previous consultation, but there was still some confusion. Therefore, I will add more on the subject.
To put it simply, when ordering tests, always put your clinical rationale for ordering the test and SEND A COPY of your report to the providing doctor or entity. Also, ALWAYS add how the test will impact your treatment plan. If you are ordering an MRI, why and how will it potentially change your treatment plan?
Sample: A cervical MRI was ordered as a result of the clinical findings in this examination to determine the nature of the space occupying lesion. Until the results have been obtained, only palliative care will be rendered. Upon receipt of the results, either aggressive conservative care will be ordered or an immediate neurosurgical consultation will be considered.
The above language should be used as part of your initial examination which includes all of your radicular or myelopathic findings. It should be sent to the MRI center as your treatment order. In your treatment plan, only palliative care is recommended. Upon receipt of the MRIs that YOU have interpreted, you then either re-evaluate the patient with the new findings or alter your treatment plan through your SOAP note to reflect the new findings and new diagnosis based upon the results.
Sample #2: Cervical, thoracic and lumbar x-rays were ordered as a result of spasm and decreased ranges of motion in each area. As the history reflects, this patient was in an automobile accident and a myriad of osseous pathology needs to be ruled out or confirmed in order to clear the patient for osseous chiropractic adjustments. Once the pathology (diagnosis) has been determined, structural imbalances need to be assessed in order to establish an accurate prognosis and treatment plan.
Sample #3: An EMG/NCV has been ordered based upon the above examination revealing signs and symptoms of radicular compression. An EMG/NCV has been ordered to determine if a neuro-selective nerve block or immediate surgical consultation is indicated.
As you can see, there are only so many variables in a chiropractic/physical medicine type practice to consider. However, there should always be a reason for why you are ordering the test and how it will impact your care. This is the formula for success and will also lower your exposure to retrospective audits because the carriers will know why you are ordering tests. No guesswork = decreased audits and increased payments to you and the person/entity performing the test. I welcome additional language should you have any suggestions and I will share them with the group to create a glossary of sample test orders.
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