New patient referrals to our clients: 824,646 Referrals as of 03/26/2019

Chiropractic, Documentation, and ICD-10

Many of the things that I am teaching you about documentation will be critical to your survival as a chiropractor certainly within the next 5 years and into the future.  With ICD-10 implementation starting in 2014 and EMR utilization being mandatory by the year 2015, it my job is to help you start and hone your skill set in this new system.  This consultation is about 2 things and I think that they go together, that is why I didn’t split it up in to two. 
Chiropractic’s effectiveness is being felt in a big way [carriers behind closed doors are realizing that we are very cost effective and can stop them from hemorrhaging cash] and it is a good thing for those that understand and are preparing for the new documentation and reporting requirements.   Here in Buffalo, we had a large third party administrator [chiropractors forming an Independent Practice Association] and providing utilization review for chiropractic services [a very common thing across the country]. This third party company had just learned that BCBS of WNY will not be renewing their contract and is bringing chiropractic utilization back in-house.  They are dropping ALL pre-authorization for care and most of the paperwork.  Here is an expert from the BCBS interview. 
“We looked at our utilization patterns and benefit restrictions and that didn’t make sense any longer,” he said. “Back care has become very complex, and a lot of surgical treatment and other treatments are occurring when more conservative treatments like physical therapy and chiropractic would work.”
Hundreds of area chiropractors currently affiliated with BlueCross BlueShield through its subcontracting relationship with Palladian will remain in network, transferring directly into the new in-house network Jan. 1 when the new plan year begins, Ram said.
BlueCross BlueShield will continue to develop the network with help from its medical management and quality improvement teams, as well as on-staff chiropractors. [Administrative consultants]
This is a great thing for chiropractic and I believe this will be a trend for the nation; however the biggest hurdle will be doctors of chiropractic learning to operate in an increasingly complex healthcare environment.  It’s not just chiropractic, with the implementation of the new healthcare law EVERYONE will be in the same boat, the rules will be the same across the board as the new law does not allow discrimination based on professional degree. Documenting within the ICD-10 parameters in particular will be a challenge for many chiropractors that don’t take EMR and inter-professional communication seriously.  To give you a little “taste”, currently ICD-9 has about 13,000 codes available while ICD-10 will have approximately 68,000!  The ICD-10 codes will be alpha numeric versus just a number.  Ex:  Spasm is listed in ICD-9 as 728.85 while in ICD-10 it will be R25.2.  The ICD-10 coding in many cases has the ability to be directional, left vs. right where ICD-9 does not.  So a patient may have left shoulder pain in one injury then come back in the next week with another shoulder injury but on the right…ICD-10 will be able to distinguish that while ICD-9 cannot.   
As a Certified Professional Coder, I need to update my training to keep my certification.  ALOT of that training is based around ICD-10 and compliance.  GUESS WHAT??? You will benefit directly from what I learn…Membership has its privileges!  Before you freak out though, remember that the new implementation date for ICD-10 is going to be October 1, 2014, it was pushed ahead a year…if you have an EMR the codes should be automatically imported into your system [if you are not sure, email me], HOWEVER you will need to document properly in order to “cross link” the ICD-10 codes to the CPT code of your procedure.  A cross link is basically where the procedure that you are providing [Spinal Adjustment 1-2 regions, jives with your diagnosis coding]. This is where the EMR Macros and Templates program comes into play.  Having research and verbiage in the proper format will make your life MUCH easier, more information on the EMR Macros program can be found at
I am in the process of positioning you to have all your documentation ducks in a row so that when this is mandatory, it will be a no brainer.  Besides, all of the things that you need to do for the ICD-10 are things that you will be doing anyway as part of this program, resulting in MORE referrals and more income while everyone else is losing referrals and losing money.  With the increase use of Evidence Based care, a chiropractic office will need to increase its exposure to patients that have never been to a doctor of chiropractic in the past.  Right now when I look at my MD referrals over the last 60 days, approximately 80% were never to a chiropractor before!  That is what I want for you; don’t fight with other offices to get a piece of the 7% of the US population that sees a chiropractor or has in the past, look to the 92%.  The EASIEST way is to build relationships with the medical community; they have patients that need you. 

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