Corporate

October 23, 2014 - Updated 01.12.16

Progressive Corrective Action (PCA) Review: Chiropractic Services

The J15 Part B Medical Review department performed Progressive Corrective Action (PCA) reviews on chiropractic services throughout the year. The findings of PCA reviews occurring over 2015 are as follows:

  • The documentation provided did not support the Local Coverage Determination (LCD) and Internet-Only Manual (IOM) for Chiropractic Treatment:
    • No treatment plan (or vague plans of care),
    • No objective measures,
    • No measurable goals,
    • No documentation of treatment effectiveness
  • The range of motion was missing from the exam.
  • No documentation of subluxation or areas treated.
  • No documentation was found to support manual treatment.
  • Failure to provide medical records for the probe review.
  • Maintenance Therapy - The documentation supported maintenance therapy.
    • The history lacked documentation to support new or active disease process.
    • Based on the history, it was difficult to determine where, or if there were breaks in treatment.
  • Wrong CPT Code - Providers billed for a higher level service than the number of areas treated.
  • Failure to provide medical records for the probe review.

For more information on Medicare guidelines, including documentation required to process a claim, please refer to:

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