Don’t Forget to Do Your PART for Medicare

For any claim that requires proof of medical necessity, the primary diagnosis has to be subluxation. Applying the PART process, in the absence of an x-ray, can help you determine whether the diagnosis is truly Subluxation. PART is an acronym for Pain, Asymmetry, Range, and Tissue; each is described below:

P

Pain and Tenderness Identify using one or more of the following:
Observation	Observe the pain the patient exhibits during the course of the examination. Document the location, quality, and severity of the pain.
Percussion, Palpation, or Provocation	During the exam, ask the patient if pain is reproduced (e.g., “Let me know if any of this causes discomfort.”).
Visual Analog Scale	Ask the patient to grade the pain from 0-10 on a visual analog scale.
Audio Confirmation	Ask the patient to verbally grade the pain from 0-10.
Pain Questionnaires	Use patient questionnaires, such as the McGill pain questionnaire or an in-office patient history form, for the patient to describe his/her pain.

A

Asymmetry/Misalignment Identify on a sectional or segmental level by using one or more of the following:
Observation	Observe patient posture and/or analyze gait.
Motion Palpation	Describe the misaligned spinal vertebrae and asymmetry.
Diagnostic Imaging	Use X-ray, CAT scan, and MRI to identify misalignments.

R

Range of Motion Abnormality Identify an increase or decrease in segmental mobility using one or more of the following:
Observation	Observe an increase or decrease in the patient’s range of motion.
Percussion, Palpation, or Provocation	Record palpation findings—include listing(s). Be sure to record the various areas involved and related to the regions manipulated.
Stress Diagnostic Imaging	X-ray the patient using bending views.
Range of Motion Measuring Devices	Devices such as goniometers or inclinometers can be used to record specific measurements.

T

Tissue, Tone Changes Identify using one or more of the following:
Observation	Observe visible changes (e.g., signs of spasm, inflammation, swelling, rigidity, etc.).
Palpation	Palpated changes in the tissue, such as hypertonicity, hypotonicity, spasm, inflammation, tautness, rigidity, flaccidity, etc. can be found on palpation.
Use of instrumentation	Document the instrument used and findings.
Tests for Length and Strength	Document leg length, scoliosis contracture, and strength of muscles that relate.

If PART is demonstrated, and the patient has a documented loss of function, there is usually medical necessity. But what if you find that your patient has entered a maintenance stage of care? Help them understand that Medicare expects them to cover the cost of that care. Check out the “Proper Scripting for the Medicare Maintenance Patient“.