This is an interesting question because it’s similar to the question, “How many angels can dance on the head of a pin?” When you think about it, it gets really crazy because nearly every vertebra has six joints. It’s conceivable that at any time one of those joints could have a new subluxation that could medically necessitate a chiropractic adjustment.
At the same time you could also have, on the other end plate, a chronic area that has reached the point of maximum medical improvement and any further adjustments to that area would be considered a wellness adjustment.
So, when you go to do a chiropractic adjustment on that segment, you’re really performing a medically necessary adjustment and a wellness adjustment. This scenario can occur all up and down the spine. There are seven cervical vertebrae, twelve thoracic, five lumbar, and additionally there is the pelvis.
You’re really dealing with a whole person that’s walking into your chiropractic clinic and there is really no way to say definitively that all subluxations for any given patient on any given day are only medically necessary or only wellness chiropractic treatment. There will always be a combination of the two.
On the other end of the spectrum you have insurers like Medicare who state that if you have more than twenty-four visits for chiropractic adjustments with a Medicare patient in a given year, you’re going to be subject to audits.
However, being subject to a Medicare audit shouldn’t determine whether you’re providing acute medically necessary chiropractic care, or chiropractic wellness care. Yet, at the same time, you do not want to run afoul of Medicare and undergo a big Medicare audit. So you need to be careful there.
Most chiropractic compliance experts will say that the line of demarcation between medically necessary chiropractic care and wellness chiropractic care for the average patient is eighteen visits. In my opinion that’s a bit ridiculous. That’s because there just isn’t a sound general rule for everyone.
Everybody is a unique case and you need to evaluate each patient individually. If you think a patient has reached a plateau and you don’t anticipate any further improvement, that’s the time that I would recommend moving them from medically necessary to wellness care and bill appropriately.
It’s really more artistry than anything else. You really just have to get a feel for each patient individually. From there you just need to go on what you know in your gut and from your experience to be true.
In some cases you will feel that it’s necessary to go over 18 visits. So, if you do exceed the 18 visits for acute chiropractic care, you may encounter issues with certain insurance companies.
In these cases it is very important to be sure your chiropractic EHr documentation in all cases remains solid and detailed.
Documentation is a big part of what will help you against any audits you may receive.
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