According to the Centers for Medicare and Medicaid Services (CMS) guidelines, chiropractors are deemed physicians in the Medicare system and for consistency throughout, the term chiropractic physician will encompass chiropractor, chiropractic doctor, doctor of chiropractic and chiropractic physician. Chiropractic physicians must document subluxation of the spine through x-ray or physical examination. The documentation of subluxation of the spine through physical examination includes the identification of two out of four criteria including: Pain/tenderness, Asymmetry/misalignment, Range of motion abnormality, Tissue tone, texture, and temperature abnormality (P.A.R.T.) with at least one of the two criteria being either A or R. Since special needs children often have difficulty expressing pain, and/or experiencing pain the way a typical child can, it is necessary to understand approaches to the special needs child that allow the doctor to evaluate and treat the child, as well as comply with insurance mandates to establish medical necessity. The purpose of this paper is to help the doctor understand approaches to document the diagnosis/diagnoses and procedures utilized for the medically necessary care of special needs children to while remaining in compliance with the billing to 3rd party payers. A case report follows to illustrate these challenges.
Author keywords: Special needs children, autism, Down syndrome, insurance compliance, Medicare, medical necessity, pediatrics, chiropractic, chiropractic physician, chiropractor
Author affiliations: EE, JEG: Kentuckiana Children’s Center, Louisville, Kentucky, United States; RD: private practice, West Hartford, Connecticut, United States
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