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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.
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“.
This weekend has been so enlightening. Thanks to Kathy and KMC University's Hands-on-Lab this weekend in Denver, I am now able to go back to the office and be equipped with the tools and systems I need to make my job EASY! I highly recommend Kathy and her staff at KMC University! Her knowledge and systems will help you and your office run like a smooth well oiled machine
