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How To Use the Evaluation & Management (E&M) Codes Properly: Part I

By Frank M. Painter|September 9, 2011|Evaluation & Management, Guidelines|

How To Use the Evaluation & Management (E&M) Codes Properly:

Part I: The 3 Key Components of the E/M Guidelines

SOURCE: Chiropractic Economics

By Kathy Mills Chang, MCS-P

Part I: The 3 Key Components of
the Evaluation & Management
(E&M) Guidelines

Jump to: Part 2 or Part 3

In order to document your history, diagnosis, and treatment of patients in accord with rules set out by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), your patient record should address: (1) Patient history, (2) Examination, and (3) Medical decision-making (MDM). These three components are addressed in the following three articles, which also make reference to the Sample Worksheet included with Part III

As regulatory and insurance guidelines tighten, the quality of your evaluation and management documentation is more important than ever before.

Just like a great story, the patient’s notes for an episode of care must have a beginning, middle, and end. This article is a review of the first of three parts of evaluation and management (E/M) documentation, and its focus is on the beginning of the patient’s story — the history. More information on the next two key E/M components will be presented in future issues of this magazine. (more…)

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Sidney Crosby Press Conference with Dr Ted Carrick

By John Wiens DC|September 8, 2011|Concussion, Neurology, Video|

Sidney Crosby, probably the best player in the NHL, and one who is certainly marketed as the face of the NHL along with Alexander Ovechkin, has been unable to play hockey since last year due to a serious concussion. Recently he has been treated by Dr Ted Carrick, a chiropractor and founder of the Carrick Institute for Graduate Studies in Cape Canaveral, Florida. Sid has made dramatic progress since starting treatment with Dr Carrick.

Here is the press conference. Dr Carrick’s remarks start at 7:40 into the clip.

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The Biological Rationale For Possible Benefits of Spinal Manipulation

By Frank M. Painter|September 7, 2011|Spinal Manipulation|

The Biological Rationale For Possible Benefits of Spinal Manipulation

The Chiro.Org Blog

SOURCE: Chapter X; AHCPR Publication No. 98-N002: December 1997

By Howard T. Vernon, DC

Manipulation is a form of treatment that dates to antiquity and has been practiced in some form in most cultures since that time (Lomax, 1997; Anderson, 1992). One of the first theories related to manipulation might be the statement attributed to Hippocrates: “Look to the spine as the cause of disease.” The theories of the early pioneers of chiropractic were firmly grounded in notions that had been widely held in the 1800s, particularly the idea of “spinal irritability” and its correlation with disease (Lomax, 1997; Terrett, 1987). Theories on the nature of the primary spinal disorder amenable to manipulation and on the mechanisms of action of spinal manipulation abound within chiropractic, osteopathy, physiotherapy, and manual medicine. The original chiropractic theory suggested that misaligned spinal vertebrae interfered with nerve function, ultimately resulting in altered physiology that could contribute to pain and disease. In recent decades, chiropractic theories about how mechanical spinal joint dysfunction might influence neurophysiology have undergone significant modification and reflect more contemporary views of physiology (Gatterman, 1995).

Spinal manipulative procedures produce a short-lasting (100-300 milliseconds), high velocity impulse into the body (Herzog, 1996; Triano, 1992). Herzog (1996, p.271) has summarized the work done on manipulative forces in his laboratory (Conway, 1993; Gal, 1995; Kawchuk, 1992; Kawchuk, 1993; Herzog, 1991; Herzog, 1993a; Herzog, 1993b; Herzog, 1995; Hessel, 1990; Suter, 1994) as follows:

“The peak and preload forces achieved in CSMT (chiropractic spinal manipulative therapy) were lowest for (manipulations) in the cervical spine” while being similar in the thoracic and lumbo-pelvic regions.
“The peak forces achieved using a (mechanical assistive adjusting device) were considerably smaller than any of the peak forces resulting from CSMT.”

There are more articles like this @ our:

Subluxation and Neurology Page

(more…)

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Clinical Brief: Depression Screening and Treatment

By Frank M. Painter|September 6, 2011|Depression Screening|

Clinical Brief: Depression Screening and Treatment

The Chiro.Org Blog

SOURCE: Topics in Integrative Health Care 2011 (June 30); 2 (2)

By Cheryl Hawk, DC, PhD, CHES

Depression is a condition seen frequently in primary care practice as well as by practitioners who treat patients with chronic pain. The U.S. Preventive Services Task Force recommends that all adults be screened for depression and those who screen positive for depression be appropriately referred for additional assessment and management. Cognitive behavioral therapy, pharmacotherapy, physical activity and mindful exercise are all accepted approaches to treatment of depression.

From the FULL TEXT Article:

Epidemiology

Depression, formally referred to as major depressive disorder (MDD), has a lifetime prevalence of 13%. When screened at a primary care visit, about 43% of patients who suffer from MDD report suicidal ideation within the past week. [1]

Depression is ranked 1st for causes of years of life lived with a disability (YLD) and 3rd for quality-adjusted life years (QALY) in older adults. [2] Depression may increase the risk of physical disability, coronary heart disease and diabetes mellitus and mortality. It is also a major risk factor for suicide. Depression has a significant economic burden; direct and indirect costs were estimated to be $83 billion in 2000. [2]

Assessment of Depression in Primary Care (more…)

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Outcomes For Adult Scoliosis Patients Receiving Chiropractic Rehabilitation: A 24-month Retrospective Analysis

By Frank M. Painter|September 5, 2011|Rehabilitation, Scoliosis, Spinal Manipulation|

Outcomes For Adult Scoliosis Patients Receiving Chiropractic Rehabilitation: A 24-month Retrospective Analysis

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2011 (Sep); 10 (3): 179–184

By Mark Morningstar DC, FACSP, FRCCM, FAAIM

Objectives: The purpose of this study was to retrospectively report the results of patients who completed an exercise-based chiropractic program and its potential to alter the natural progression of adult scoliosis at 24 months after the clinic portion of treatment was concluded.

Methods: A retrospective chart review was conducted at 2 spine clinics in Michigan, USA. Each clinic uses the same chiropractic rehabilitation program to treat patients with adult scoliosis. Multidimensional patient outcomes included radiographic, respiratory, disability, and pain parameters. Outcomes were measured at baseline, at end of active treatment, and at long-term follow-up.

Results: (more…)

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Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

By Frank M. Painter|September 3, 2011|Guidelines, Neck Pain, Spinal Manipulation|

Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Aug 27)

Donald R Murphy, DC, DACAN, and
Eric L Hurwitz, DC, PhD

Background: Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP.

Methods: Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG.

Results: Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.

Conclusion: The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as interexaminer reliability, validity and efficacy of treatment based on the DBCDG.

The FULL TEXT Article

BACKGROUND

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and the

A Clinical Model for the Diagnosis and Management Page

(more…)

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