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Frank M. Painter

About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

ICD-10 Guidelines and Code Changes Take Effect October 1, 2021

By |September 30, 2021|ICD-10 Coding|

ICD-10 Guidelines and Code Changes Take Effect October 1, 2021

The Chiro.Org Blog

SOURCE:   Illinois Chiropractic Society

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO


The World Health Organization and the Centers for Medicare and Medicaid Services have released the diagnosis code updates for the fiscal year 2022. The changes in codes and guidelines take effect on October 1, 2021, and affect all services rendered on or that date. Therefore, all offices must be aware of the changes and assess how the changes will impact your office. Ignorance or a lack of action on your part may lead to denials or recoupment.

Unlike FY 2021, there are not as many code changes this year, but the impact may still be the same in your office. 165 new codes have been implemented this year, compared to 485 codes last year.

In addition, there were updates to the ICD-10-CM Official Guidelines for Coding and Reporting. Every physician and their staff should remember that it is imperative to “code to the highest level of specificity.” Insurance carriers base their reimbursement on the codes you list on the claim form. A non-specific code yields limited information and will yield a limited amount of approved treatment. It is essential to review the guidelines and the new codes to ensure you are assigning the most appropriate codes.

Among the notable guideline changes are involving laterality. When the patient’s provider does not document laterality, code assignment for the affected side may be based on medical record documentation from other clinicians. Codes for an “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side, and it is impossible to obtain clarification. Any unspecified code is deemed a red flag in coding. Be specific.

In the past, the provider or their staff had to confirm a condition. The guidelines now state that exceptions will allow the doctor to report information gained from outside records.

These would include the following:

  • Body Mass Index (BMI)

  • Depth of non-pressure chronic ulcers

  • Pressure ulcer stage

  • Coma scale

  • NIH stroke scale (NIHSS)

  • Social determinants of health (SDOH)

  • Laterality

  • Blood alcohol level


Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

By |July 3, 2021|Initial Provider, Opioid Epidemic|

Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

The Chiro.Org Blog

SOURCE:   Archives of Phys Med and Rehabilitation 2020 (Aug)

Christopher J. Louis, PhD, Carolina-Nicole S. Herrera, MA, et. al.

Department of Health Law, Policy, and Management,
Boston University School of Public Health,
Boston, Massachusetts.

Objective:   To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain.

Design:   Retrospective cohort study.

Setting:   Marketscan research databases.

Participants   : Patients (N=427,966) with new-onset neck pain from 2010-2014.

Main outcome measures:   Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings.

Results:   Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%–91% less likely to fill an opioid prescription in the first 30 days, and between 41%–87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47–3.69; P<.001).

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Initial Provider/First Contact Section


Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

By |June 8, 2021|Nonpharmacologic Therapies|

Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

The Chiro.Org Blog

SOURCE:   Translational Research 2021 (Apr 24);


Steven Z George, Trevor A Lentz, Christine M Goertz

Department of Orthopaedic Surgery and
Duke Clinical Research Institute,
Duke University,
Durham, North Carolina.

Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain.

First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.

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Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review

By |June 1, 2021|Uncategorized|

Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review

The Chiro.Org Blog

SOURCE:   Frontiers in Neuroscience 2020 (May 8); 14: 430


Carla Rigo Lima, Daniel Fernandes Martins and William Ray Reed

Rehabilitation Science Program,
University of Alabama at Birmingham,
Birmingham, AL, United States

Background:   Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions

Methods:   PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Index of Chiropractic Literature (ICL) were searched from database inception to August 2019. Eligible studies were:

(a)   published in English;
(b)   non-cadaveric animal-based;
(c)   original data studies;
(d)   included a form of MT or simulated MT as treatment;
(e)   included quantification of at least one delivery parameter of MT treatment;
(f)   quantification of at least one physiological measure that could potentially contribute to therapeutic mechanisms of action of the MT.

MT studies were categorized according to three main intervention types:

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What is the Chiropractic Subluxation? Page


Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

By |May 14, 2021|Chronic Low Back Pain, Chronic Neck Pain, Chronic Spinal Pain, Whiplash|

Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

The Chiro.Org Blog

SOURCE:   Clinical Journal of Pain 2020 (Dec)


Martin K Rasmussen 1 2, Alice Kongsted 3 4, Tina Carstensen 5 6, Troels S Jensen 1 6, Helge Kasch 6 7

1   Danish Pain Research Centre Aarhus University Hospital.

2   Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark.

3   Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.

Objective:   The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata.

Design:   E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740).

Methods:   Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity.

Results:   The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms.

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