Purpose
The purpose of Private Insurance Practice is to provide acute and chronic care to patients and provide documentation to allow their insurance to cover that care. This care is to include Diagnosis and Treatment for any condition or injury that would be helped through Chiropractic Treatment and covered by the patient’s insurance.
Adjusting Technique
SDCA recognizes any Chiropractic Adjusting Technique that is well documented.
Therapeutic Care
SDCA recognizes any therapeutic treatment that does not violate BOCE Laws.
Intake Information
- All the information contained in Sec. §318. Chiropractic Patient Records/Accountable Billings.
- Patients Full Name
- Patients DOB
- Patients SS# If Available SDCA does not require asking why the SS# in not available
- Patient Gender
- Height & Weight SDCA’s Standard is to allow the patient to supply this information when possible.
- SDCA recognizes that asking for weight may present a psychological distress that can become a physical distress. SDCA sets the Standard to address this by estimating height and weight.
- Patient History
- In order to be compliant with the BOCE, SDCA recommends asking about the following history items. The following items are derived from Medicare Standards. SDCA makes no recommendation regarding someone with one of these conditions being adjusted.
- Spinal Surgery
- Spinal Fracture
- Spinal Dislocation
- Spinal Tumor
- Spinal Infection
- Ankylosing Spondylitis
- Spinal Rheumatoid
- Myelopathy
- Vertebrobasilar Insufficiency Syndrome (VBI)
- Arthropathies
- Spinal Bone Demineralization
- Spinal Joint Instability
- Major Artery Aneurysm near the Spine
- Other health history issues
- Complaint
- Analysis/Evaluation
- Diagnosis
- Treatment
- Informed Consent
- SDCA sets a Standard of known risks to include the following:Symptoms following an Adjustment during the healing phase.
- The un-likely risk of stroke.
- The risk of not getting Adjusted.
- Doctors Signature
- Patient Signature
- SDCA recognizes any form of documenting office visits including but not limited to having the individual seeking Chiropractic being responsible for logging their office visit through their cell phone or an EM device.
examination
SDCA sets a Standard of performing only the Examination procedures necessary in order to evaluate the patient for the reported complaints.
SDCA recommends following Medicare Standards for performing Examinations and Re-Examinations when ever possible.
Orthopedic Tests
SDCA does not recognize the need for any test that the Chiropractor performing the examination does not deem necessary for the evaluation of the patient.
Treatment Documentation
- Date of Service (DOS)
- CPT Code
- ICD-10 Diagnosis Code
- Signature of Patient on every visit
- Chart note on every visit
- SDCA recommends using Medicare Standards when ever possible
- Any documentation required by the responsible Insurance Coverage.
length of treatment
SDCA does not set a Standard for the length of time a patient can be seen for Insurance Covered Care.
Medicare Documentation
SDCA Recommends following Medicare Documentation Standards when ever possible for Private Insurance Care.
SDCA 