Guidelines for Emergency Room Chiropractic Reimbursement

I kid you not.  Read the excerpt, the the article (especially the clinical vignette included), then read my mea culpa at the end.  In that order please, no skipping around.   Emphasis mine:

Guidelines for Emergency Room Chiropractic Reimbursement

It is crucial that those involved in clinical case management, both in the hospital and the insurance industry, be familiar with the appropriateness and indications for chiropractic care in the hospital setting. In 1987, the American College of Surgeons published a position paper that approved of the association with chiropractors in the hospital setting. Their statement read, in part, as follows:

…

In my six-plus years of being on-call in the hospital emergency department (ED), I have seen numerous ED physicians gain familiarity with the indications for chiropractic consultation. I have enjoyed seeing the attending physicians learn to appreciate the role of the chiropractor in the ED. Even more enjoyable is witnessing the ED physician’s growing dependence on their staff of chiropractors.

…

The following case history illustrates an example of an ED patient whose insurance company denied reimbursement until receiving further explanation…

This case involved a woman suffering from a severe and disabling headache. The attending ED physician evaluated her condition. She discovered that the patient had a long history of migraine headaches, for which she had been under the care of a neurologist. For the past week, the patient had suffered progressively worse headaches that were not relieved by numerous prescriptions or over-the-counter medications. The ED attending physician had to consider co-morbidities and other risk factors, including the patient’s history of a previous CVA. After obtaining the appropriate imaging studies, the attending diagnosed the patient as suffering from migraine with cervical tension cephalgia characteristics. The patient had already self-medicated with Imitrex at home. The attending first ordered administration of Toradol, a potent nonsteroidal anti-inflammatory drug. When Toradol did not relieve the patient, the attending ordered Demerol, a strong narcotic analgesic. When Demerol failed to provide relief, the attending had to consider additional treatment options.

I’m here to confess myself a sinner.  I have referred patients for chiropractic care (while in the military, on Active Duty).  I can explain.

In my ‘practice’, involving only adult males in excellent physical condition with an average age of 21 (Marines and Sailors) there were always a few who had acute and occasionally chronic neck and or lower back pain.  As these excellent specimens of the human form had to routinely hump packs of 80 plus pounds for miles, and wear a helmet heavier than their head while doing so, I wasn’t really surprised. 

I was surprised that they, and our mutual Commanding Officer, expected them to be completely well and 100% with a day or two of Motrin (they called me King Motrin on the boat, and I carried a full bottle with me for those who presented in the passageways with “…and it hurts”, getting some Motrin from me) and light duty, and it quickly became obvious that a) Base Hospital Physical Therapy was a lot more interested in post-op patients and their schedules were full, b) the CO expects me to Do Something, and c) there’s this new Chiropractic service opening up, and they have a lot of slots and are advertising for troops with back pain.  No-brainer.  Off go the consults, and then if they aren’t quickly returned to duty, it’s no longer on me.  Sorry, that’s how it worked.

I do not anticipate becoming dependent on chiropractic consults in my ED practice for a while.  And I cannot keep up with my own billing, let alone theirs.