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How would one go about separating treatment of the same area affected by both a pre-existing condition (PEC) as well as new injury?
There are differing ways in which a PEC could present itself. If we are speaking of a musculoskeletal PEC, they can present as an underlying condition (DDD, DJD) and a new injury usually layers over it. These are almost impossible to separate, but you must try to treat them separately and “prove” that to be ineffective and that you will need to treat them both at the same time. Remember, the insurer needs evidence of a good faith effort to treat them separately. They may request an apportionment. My experience is that any apportionment I have offered is usually in the single digit range, unless a prior impairment or treatment record can be used to specifically separate the 2 injuries.
You can also start by trying to treat an underlying condition, the symptoms of which can be obtained from the patient (i.e. stiffness on rotation, verses the new injury is stiffness inflexion.) you will need to work on rotation and flexion separately. The order of treatment priority is difficult to determine, but one should be favored over another. The treatment would be documented as a part of the injury record, but with separate notations for the PEC since it will receive an apportionment request.
If you do not separate out that treatment, you will get a whole case apportionment. The PEC apportionment will be based on the effect the PEC was having prior to the MVC. Assign your professional estimation a %, and then bill your full amount and let the insurer apply the %reduction you have stated (i.e.: 5% PEC from a $100 bill, would amount to a $5 reduction at the time of reimbursement). Don’t do their work for them. I have had some cases never receive an apportionment reduction because the insurer didn’t get around to it.
Avoid the costly mistake of underestimating “when” the insurer may apply the discount. They may wait until the end of care and make an accrual deduction from the final settlement or they may periodically make a reduction when paying your bills (PIP/Med-Pay). Regardless of the method, when you have apportioned care, you agree with their making a reduction at some point during the recovery care cycle. If the injury is to an extremity, often you can isolate the effected muscles, tendons, joint function of the PEC from a new injury to a different portion of the joint complex. Specificity reigns on this. If that PEC has been aggravated, treat it first, if possible, and then change the treatment plan as needed to reflect the shift in care from the alleviated PEC and the new injury’s care.
If the PEC is a disease state (Diabetes, obesity, Atherosclerosis, etc.), then you will need to co-treat with another professional and make allowances for altered care. Obesity, for example, oft times interrupts a productive exercise regimen. The patient cannot help that a driver negligently injured them. Now the recovery is difficult due to a “fitness” PEC. You may find that the patient must be put on a dietary regimen to more fully recover from their injury (i.e.: LBP, NP). After trying to restore their health to pre-MVC you may need to inform the insurer that the patient will need to undergo weight loss to recover the injured body part. The insurer may balk at having to pay for that. A skilled attorney will know how to combat that issue. If weight loss cannot be achieved, ofttimes due to the injury you’re trying to treat, then that injured body part injury may be deemed permanent and an impairment issued.
When is the best time to do an Exit Exam?
When the patient has reached a plateau of no change for a period of 2 weeks and you have offered alternative treatment regimens to no avail, then it’s time for the exit exam. There are times when a patient suddenly quits care. In that case you can conduct a telemedicine call to get a final status from the patent and a reason for stopping care and make a record entry for that call (which is a billable call – See D&C of Communications audio training) and detail as much as you can about their ADL’s due to the injury and the best “plausible” reason for their having stopped care in your office. I would recommend that if it’s a question of money, that you offer to perform the exit exam at no charge, so that you can protect the investment of the care from unreasonable insurer reductions because the patient was deemed to be non-compliant. Get the exit exam if possible.
When is a report sent to the Insurance Company?
An initial exam report is sent to the insurer within the first several days after the initial exam. Updates to that exam (x-rays, additional diagnostic testing, etc.) are sent to the insurer as completed and always within a few days of the exam/re-exam being performed. Your “working” diagnosis provides the platform for the reserve being set, which is why you need to list every possible, plausible injury and symptom finding from your initial exam/scouting exam intake and then proceed to confirm or disallow each coded injury and symptom using the additional exams and diagnostic testing that you are being trained to perform.To recap:
- The initial exam is performed on the first date of intake
- The 1st re-exam is performed at 31 days post MVC
- The 2nd re-exam is performed 31 days post 1st re-exam. Subsequent re-exams are performed at 31 days post previous re-exam.
An MVC Patient ACE Score is 11/22, How do I Grade This?
The scoring is cumulative. 11/22 is a rather high score. Their symptoms need to be recorded on the Potential Head Injury Questionnaire (PHIQ).
If the patient has a close acquaintance (family member, significant other, friend) who can provide feedback via also filling out the PHIQ, identify that addition survey form as coming from the “Informant”, the name of a symptom/incident witness in Med-Legal terms.
This process can be used for as many additional informants as needed that can shed new light and confirmation of fact regarding the patients claim of injuries, symptoms and the injury event. Usually 1-2 will suffice, but no real limit is stated.
Be certain to document the MOI and send these records along with your physical exam findings and impressions (why you feel his/her symptoms warrant referral to another specialist) to the neuropsychologist.
In the Self Care Reports, What Is The Difference Between What You Put In The “[insert history]” Section Vs. The [insert home treatments]” Section?
It’s helpful to identify how the injury occurred as described by the patient and what those effects have been on the ADL’s.
The home treatments are meant to show detail regarding the level of the patients deliberate efforts to self-treat and minimize their symptoms, not simply a bland comment about undisclosed efforts about how they have been coping.
It’s been shown that generic descriptions usually lead to minimized reimbursements.
Should I Use Crash Vs. Collision In My Reporting?
Collision is a fine word, but crash is more expressive. It conveys more severity in a courtroom. It’s all about the dynamics of presentation.
What If My Patient’s PCP Didn’t DX Him/Her With A Concussion?
Chiropractors are licensed to find concussions, even when other doctors do not, even when time has passed without the concussion having been discovered by those other doctors.
The key in your case is to document the MOI, use the right assessment tools (ACE & Potential Head Injury Questionnaire PHIQ) and then refer to a neuropsychologist for confirmation and treatment recommendations. CT’s and MRI’s are usually not conclusive by themselves, except in cases where there is unmistakable tissue damage and brain bleeds.
Where Can I Find Fast, Easy and Complete ICD-10 Coding?
ICD-10 coding training can be obtained from ChiroCode.com.
Where Do I Find Colossus Level 1 Handouts/Resources?
Course handouts (now called resources) are located in the Education Portal under Colossus Level 1 Course. You can download resources in two ways:
All at Once
You can download all resources by clicking “Download All Course Resources”. This does not include the transcript for the full course. That can be found to the right on the same page.
Click “Launch Module [#]” for the desired module resource(s). Once the Module launches, click “Download Module Resources”.
Am I Able To Do An Earlier Module On Colossus Level 1?
Yes, once you have purchased Colossus Level 1 Training, you are able to complete each module and the course at your own pace, either within a year or if you’re a Monthly Coaching Client, you have access for as long as you’re a paying subscriber. Currently, the modules are being updated, so check back often for new information.
How Do I Know When To Take Each Module?
One of the greatest benefits of Pragma Intel’s Colossus Training is that you are able to take each Module and the course at your own pace in a one year time span, or if you’re an active Colossus Monthly Coaching Client, you can take as logn as you’d like.
You are able to take each module one after another. It’s recommended you complete the previous module before moving on to the following one.
Is There a Module on ICD-10 Coding?
There are no coding specific modules in the Colossus Level 1 Training course, however Colossus Level 1 training does offer codes on certain subjects throughout the course.
In our Colossus Level 2 training, we will go deeper into coding topics (currently in the works). We are hoping to develop a coding compendium in the future. In the interim, there are some good coding courses offered in the marketplace and Dr. Grant recommends any courses offered by Evan GWilliam, DC of ChiroCode.com and Brandy Brimhall of Find-A-Code.com.
Have additional questions? Contact us.