when to treat patients - chiropractic services

NECESSITY FOR TREATMENT

A. The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by X-ray or physical exam, as described above.

Most spinal joint problems may be categorized as follows:

* Acute Subluxation: A patient’s condition is considered acute when the patient is being treated for a new injury identified by X-ray or physical exam as specified above. The result of chiropractic manipulation is expected to be an improvement in, arrest or retardation of the patient’s condition.

* Chronic Subluxation: A patient’s condition is considered chronic when it is not expected to significantly improve or be resolved with further treatment (as is the case with an acute condition), but where the continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition without expectation of additional objective clinical improvements, further manipulative treatment is considered maintenance therapy and is not covered.

B. Maintenance Therapy: A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing chiropractic treatment is not considered to be medically reasonable or necessary and is not payable under the Medicare program.

C. Contraindications: Dynamic thrust is the therapeutic force or maneuver delivered by the physician during manipulation in the anatomic region of involvement. A relative contraindication is a condition that adds significant risk of injury to the patient from dynamic thrust but does not rule out the use of dynamic thrust. The doctor should discuss this risk with the patient and record this in the chart. 

The following are relative contraindications to dynamic thrust:

* Articular hypermobility and circumstances where the stability of the joint is uncertain.

* Severe demineralization of bone.

* Benign bone tumors (spine).

* Bleeding disorders and anticoagulant therapy.

* Radiculopathy with progressive neurological signs. 

Dynamic thrust is absolutely contraindicated near the site of demonstrated subluxation and proposed manipulation in the following:

* Acute arthropathies characterized by acute inflammation and ligamentous laxity and anatomic subluxation or dislocation, including acute rheumatoid arthritis and ankylosing spondylitis.

* Acute fractures and dislocations or healed fractures and dislocations with signs of instability.

* An unstable os odontoedeum.

* Malignancies that involve the vertebral column.

* Infection of bones or joints of the vertebral column.

* Signs and symptoms of myelopathy or cauda equina syndrome.

* For cervical spinal manipulations, vertebrobasilar insufficiency syndrome.

* A significant major artery aneurysm near the proposed manipulation.