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Diagnostics: The Necessity of Documentation
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Written by Suzi Plank   
Tuesday, 08 June 2004 20:14

There are probably very few chiropractors today that have not been asked to justify the necessity for the treatment, therapies, procedures or diagnostic tests rendered or ordered for patients.  What happens in your office when such a request arrives?  Are you able to review the patient’s file and readily provide the appropriate information?  Do you then generally receive payment or additional authorizations for the disputed treatment or procedures?   The phrase “you can’t win them all” is sometimes applicable with these requests.  However, if you “lose” more than you “win”…you need to analyze your documentation process.



History, notes and consistency form the backbone for successful documentation.  The use of automated claims analysis by payers is increasing.  If you submit claims for payment to an outside payer, whether health, auto, worker’s comp or others, your notes should provide validation of the need for the treatment and services.  Supplying documentation to payers that is illegible, incomplete or does not follow logical criteria will only serve to place you firmly on their “watch” list, and you will receive even more requests for notes and necessity.

Diagnostic tests and procedures are tools that can help justify medical necessity for treatment.  Some may require substantiation for their use.  Do you have guidelines that you follow within your practice when making the decision to order, refer or perform a diagnostic procedure?  Are those guidelines reflected in the patient’s chart notes…even those for whom testing was not subsequently necessary? 

Good documentation should help “set the stage” for your treatment and use of diagnostics from the initial exam.  Do not wait until after the additional visits, therapies or testing have been ordered or performed before mentioning the possible need.  Consider the “if…then” phrase like that used in computer program filters.  An example of the thought process is that “if” a symptom, response, result, etc., is present, does not resolve, etc., “then” treatment, therapies, testing, referral, etc., is or may be indicated.  Regular comments and updates should be made on previous areas of positive findings, emphasizing those that are an indication for additional treatment or testing.  

A crucial element considered by payers when reviewing documentation and necessity is the doctor’s recognition of the information obtained through examination, history and diagnostics.  Failure to review or acknowledge the outcome of test results, whether positive findings or not, is viewed in a most negative light by payers.  Diagnostic test results found to be in normal limits does not mean there was no benefit gained from that knowledge.  If the information could be disregarded, why was it done at all?  Reimbursement may be unobtainable if the procedure is one for which you billed. 

At this point the chart should reflect the progression of your exam findings, treatment and rationale for use of diagnostics and acknowledgement of the results.  What is the real purpose of obtaining this information?   Most of us would agree the primary purpose is to restore the patient to health.  Certainly, in today’s medical and legal climate, limitation of liability must be considered as well.  When reviewing for medical necessity, payers are asking if and how the patient benefited from the treatment or diagnostics.  The findings of your exams, X-rays and other diagnostics are noted and recorded…but now you must also relate how the information was of benefit to the patient.  Documentation should reflect how you utilized the information you gathered.  Like “if…then”, the key word for consideration at this point of documentation is “because”.  Was new information obtained?  Was the previous diagnosis confirmed?  Was the treatment plan changed or modified “because” of this new or confirmed information?  These are just simple examples.  An integral element in the documentation should be the impact of the exam findings or diagnostic results on the patient’s treatment or recovery plan.

Diagnostic tools offer you the needed resources to provide the best possible care and the most comprehensive treatment for your patients.  Without good documentation you lose that advantage.  Diagnostics that are rejected for “lack” of medical necessity are usually deemed to have no value in justifying additional treatment or therapies.  Remember, if it isn’t in writing…it didn’t happen! TAC

Ms. Plank has an extensive background in medical and facilities management.  Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory.  During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology.  She is currently the Vice President of Corporate Services for Practice Perfect.  Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Other Articles
Written by TAC Staff   
Saturday, 03 April 2004 17:31


ZT Technical Services, LLC


Debbie Hugg
ZT Technical Services, LLC
Tel: 1.800.209.8899
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it




ARLINGTON HEIGHTS, Ill.—May 2004—Mitchell E. Rubin, President and CEO of ZT Technical Services, LLC, the nation’s leading provider of on-site precision electrodiagnostic testing services, was interviewed on May 5, 2004, by the award-winning medical series Health Journal Television (HJTV), hosted by former US Secretary of State, General Alexander Haig.

The May 5 taping is scheduled to air on June 4, 6 and 7, 2004, on Tech TV, CNBC and Bravo networks (as paid programming). The segment will feature a tour of ZT Technical Services’ headquarters located in Arlington Heights, Ill., along with an exclusive one-on-one interview with Mitch Rubin. “Participating in this medium provides tremendous opportunity to reach private and small group practice physician specialists on a national level,” states Rubin.

The informative presentation will provide viewers with an educational overview on how they can build a stronger, more profitable practice through utilizing on-site ancillary services—specifically, electrodiagnostic (EDX) and electromyogram (EMG) testing. Physicians can provide more convenient, better patient care. At the same time, they can create a secondary profit center within their own practice by offering patients these types of services maximizing their per-patient reimbursements.

“Our message during this televised medical segment will underscore that providing advanced on-site testing can help physicians to better compete within the medical field,” says Rubin. “Offering patients traditionally referred-out services on-site helps to create a level playing field for private-practice physicians who are competing with hospitals and freestanding clinics for the same patient base. Our extensive array of advanced testing services provides physicians with the tools necessary to remain on the cutting-edge of health care, as well as the ability to grow and develop their practices for future success.”

The Health series targets medical professionals and hospitals including physicians, nurses, administrators, ancillary staff, patients and families. The premise of HJTV, is to educate the business and consumer audience in an informative, objective format on the latest technologies, strategies and approaches impacting corporations, operations and the public at large.

Since ZT’s successful inception in the late 1990s, Rubin has created three affiliated organizations. Diagnostic Testing Centers of America (DTCA), ClarigoMed, LLC and HTZ Technical Services, Inc. Each organization delivers advanced on-site testing solutions and services offering unique, compliance-driven practice models designed to fit each physician’s particular practice needs.

Airing June 4, on:
· Tech TV at 6:30 a.m. EST

Airing June 6, on:
· CNBC at 11:30 p.m. PST (as paid programming)

Airing June 7, on:
· CNBC at 2:30 a.m. EST (as paid programming)  

Bravo airing 7:00 a.m. EST/PST pending (as paid programming). Check your local listings for upcoming dates and times.

Be sure to visit www.zttesting.com for more information about getting started with on-site EDX testing.

Headquartered in Arlington Heights, Ill., the company has additional offices in Boca Raton, Fla. For additional information, contact 1.800.209.8899 or visit the Web site at www.zttesting.com.

Upcoming Seminars
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Written by TAC Staff   
Saturday, 03 April 2004 17:26

Seminar dates – May & June


Anabolic Laboratories:


May 22–23, Levittown, NY; June 24–25, Allentown, PA. For more information, call 1-800-445-6849 or visit www.anaboliclabs.com.     


Breakthrough Coaching


May 20–22, Crowne Plaza Times Square, New York, NY; July 10, Sheraton Newark Airport, Newark, NJ. For more information, call 1-800-723-8423 or visit www.mybreakthrough.com.


Chiropractic Leadership Alliance


May 21–23, Puerto Rico; June 17–20, Minneapolis, MN. For more information, call 1-800-285-2001 or visit www.subluxation.com.


David Singer Enterprises


May 1–2, San Francisco, CA; June 19, Atlanta, GA. For more information, call 1-800-326-1797 or visit  www.davidsingerenterprises.com.


DMX Works


May 28–29, Cayman Islands. For more information, call 1-800-839-6757 or visit www.dmxworks.com.




May 15-16, Des Moines, IA; June 5, Virginia Beach, VA. For more information, call 1-800-553-4860 or visit www.footlevelers.com.


Fred Van Liew’s  Water & Air Essentials


April 24, Dallas, TX. For more information, call 1-800-964-4303 9-6 CST or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .




April 29–May 2, Long Branch, NJ. For more information, call 1-610 565-2360 or visit www.icpa4kids.com/chiropractic_pediatric_seminars.htm.

Integrated Expo  


May 13-16, Chicago, IL. DC/MD/PT Seminar. For more information, call 1-888-67-DAHAN or visit www.dahan.com.


Loomis Institute of Enzyme Nutrition


June 12-13, Dallas, TX. For more information, call 1-800-662-2630 or visit www.loomisenzymes.com.


The Masters Circle


May 14-15, Los Angeles, CA; June 4-5, East Rutherford, NJ. For more information, call 1-800-451-4514 or visit www.themasterscircle.com.




May 1–2, Denver, CO; June 26–27, Reno, NV. For more information, call 1-800-443-3333 or visit www.nutriwest.com.


Parker Seminars

June 17-20, Minneapolis, MN. For more information, call 1-888-727-5338 or visit www.parkerseminars.com.

National Associations News Update
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Written by TAC Staff   
Saturday, 03 April 2004 17:21

American Chiropractic Association



Speaker Of The House, HHS Secretary Applaud Chiropractic at ACA’s National Chiropractic Legislative Conference


House Speaker Dennis Hastert and Health & Human Services Secretary Tommy Thompson each paid visits to ACA’s National Chiropractic Legislative Conference (NCLC) to acknowledge the contributions of DC’s to our nation’s health care system and to encourage ACA members to continue their grassroots lobbying efforts.  ACA also welcomed more than a dozen members of Congress to the conference.



From March 3-6, over 450 doctors of chiropractic and chiropractic students converged on our nation’s capital to urge elected leaders to support chiropractic legislation. 



According to Thompson, who made his third visit to NCLC, “As the national voice for the chiropractic profession, ACA has contributed significantly to improving the lives of countless Americans.”



Meanwhile, House Speaker Dennis Hastert, a former football and wrestling coach, thanked chiropractors for helping get kids back on their feet.  According to Hastert, “A chiropractor is someone who can get people well without giving them a pill.”  Hastert also recognized the work of Dr. William Morgan, the DC who practices at the Bethesda Naval Medical Center and in the Office of the Attending Physician at the U.S. Capitol.  “As word gets around, his office is getting busier and busier,” explained Hastert.  The House Speaker also discussed his critical role in getting the ACA-backed Medicare chiropractic demonstration project passed.



“I’m blown away, not only by the sheer number of ACA members who participated in this NCLC, but by the enthusiasm of everyone involved,” said ACA President Donald Krippendorf, DC.




International Chiropractic Association



Governor Arnold Schwarzenegger Delivers Inspiring Address to ICA Fitness Symposium:


Focuses on Service, Health And Responsibility 




For the 12th consecutive year, global superstar and chiropractic supporter, and now Governor of California, Arnold Schwarzenegger was the featured speaker at ICA’s Symposium on Natural Fitness held March 5-6, in Columbus, Ohio.  Speaking to over 400 participants, Governor Schwarzenegger told the crowd, “I am honored to be back with you and to celebrate this great weekend once again.  We share a common mission, and that is health and fitness for everyone.” 


Governor Schwarzenegger also thanked the ICA for its longstanding partnership and support, and acknowledged ICA’s leaders as “key contacts” for the work he is engaged in as Governor.  ICA honored Governor Schwarzenegger this year with the presentation of a San Francisco 49-ers official helmet, inscribed, “To Governor Arnold, The Captain of Our Team,” and embossed with an engraved gold disc from the ICA Council on Fitness, autographed by all-time great running back Roger Craig, who was one of the main speakers at this year’s program. 


Governor Schwarzenegger also met privately with a delegation of ICA leaders on the very difficult and much discussed workers compensation situation in California.  Dr. John Maltby, ICA’s Western Regional Director, ICA’s Assembly Representatives for California, Dr. James Musick, and Dr. Brian Porteous, as well as ICA Executive Director Ronald Hendrickson participated in what can only be characterized as positive, direct and productive talks.  Such discussions are part of ICA’s on-going dialogue with the Governor and his senior representatives on a wide range of issues important to the chiropractic profession. 


For more information, contact the ICA at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit www.chiropractic.org.




World Chiropractic Alliance


Chiropractic Research Generates Widespread Television Coverage




A press release about research into chiropractic and fertility, distributed by the World Chiropractic Alliance (WCA), has generated widespread coverage on television stations around the nation.



Madeline Behrendt, DC, lead researcher for the series of articles in the Journal of Vertebral Subluxation Research (JVSR), was spotlighted on a special syndicated television news feature. Dr. Behrendt is a member of the WCA International Board of Governors and chair of the WCA Council on Women’s Health.



The taped segment was distributed to news outlets around the country and aired on major television news programs in New York, Philadelphia, Seattle, Boise and other cities. Many of the stories were also placed on the Internet, either in print or video format. A link to the story was also included on the website of The American Society for Reproductive Medicine.  For links to online TV news videos and stories, visit the WCA website at www.worldchiropracticalliance.org.



In the interview, Dr. Behrendt made certain the audience understood what chiropractic was really for. “The chiropractor identifies spinal distortions, which are called subluxations, and once they were detected and corrected, the fertility function improved,” she explained.


According to the Centers for Disease Control, more than six million women in the United States are infertile and over nine million use some kind of infertility service.


“I think this proves that we can generate positive publicity for the profession without shying away from the word subluxation or spending millions on paid programming or advertising,” says Terry A. Rondberg, DC, WCA President.

Bridging the Canyon of A New Understanding
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Written by Bruce Goldsmith   
Saturday, 03 April 2004 17:19

Fifteen years ago, a DC told me, “In a perfect world the best patient education would be self extinguishing.”  Why?   “Because everyone would always understand where health comes from and would demand chiropractic care.”

The world is still far from perfect.  Just last week I heard of a “healthy” 45-year-old who woke up with heartburn and a headache.  He treated it the way his TV and pharmaceutical companies told him.  He took pills for the heartburn, but it didn’t go away.  He treated the symptoms rather than seeking professional help.  The next morning he didn’t wake up, because he had had a massive heart attack.

As you know, the “symptom vs. cause” canyon is deep and wide, but it is being successfully traversed by many enterprising and persistent chiropractors.  How?  They use materials that communicate instantly, are in perfect harmony with their philosophy, and their message is repeatedly reinforced.

To cross this great divide, you must somehow get the first rope across.  Whether you throw it, or climb into the canyon pulling it behind you, without that first line, you cannot build a bridge.  On the other side stand your patients solidly rooted in symptom relief dogma.  You stand on your side resolutely poised to teach them your “truth”.  Sometimes it seems that you’re both so very far away. 

So, go ahead.  Start by throwing them a “life line”.  Acknowledge their initial complaints with visuals and discussion about how successful chiropractic can be at helping with complaints just like theirs.  Show them that you recognize that their pain was motivating them to find you in the first place.  Once they’ve arrived on your side, you can make the bridge strong and sturdy with posters, models, electronic nerve charts, and videos, plus passive and interactive computer software.  Remember to take advantage of their ability to explore pamphlets, videos and, especially, computer programs and games at home, on their own.  These lay a great foundation for family involvement.

In your office, a strong ROF(Report Of Findings) is the basis for their understanding and acceptance.  It is here that you shift their primary focus from pain relief to a, “Let’s keep this from getting worse,” mentality.  And, finally, “Now, let’s keep your improvement.”  Either electronic wall charts or computer programs will show them, not only the type of symptom that they are currently experiencing, but, also, on a performance level, what muscles might be impacted by those same subluxations.  The most useful visual aids will simultaneously show them how the organs rely upon a clear and functioning nerve system for proper expression of health.

Your group orientation helps smoothly pave the bridge’s surface while saving time in getting your message out more effectively.  A great way to do this is with some dramatic visuals.  Traditionally, flip charts have been very useful for this; but, with the advent of inexpensive computer monitors and projectors, it is much more exciting and memorable to use graphics and animations that “come to life”.  It’s easy, too.  Good interactive and customizable software takes you “by the hand”, making talks lively, fun and virtually effortless.

For ultimate success in getting the public across to your side, you must have an office environment that is inviting, modern and congruent with your philosophy.  This provides the comfortable vehicle for their journey with you.  Daily or, at least, weekly topic discussions that are team delivered will keep your bridge full of traffic and constantly moving along.

You must earn the right to teach your patients that there is something better than just symptom relief.  The only way that you can do that is by starting where they are now.  Make sure that you have patient education tools that demonstrate the health potential reduction and life stealing effects of subluxations left uncorrected.  Build rapport and then present the chiropractic solution.  This is how you shift their paradigm and help them cross the canyon and stay there.

Bruce Goldsmith is President of Visual Odyssey.  He invented the Neuropatholator® wall chart systems in 1976, and has been making chiropractic patient education tools, including the very popular SHO® flip chart, ever since.  You can reach Bruce at 800-541-4449 or 770-646-8031.  For more information, visit www.chirocharts.com.


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