We deserve equal pay for the special value attributable to our service

April 29, 2002

y,

Good idea, but it might be more practical for each of us just to come-up with our own isolated cases. Here's one for you...

I go to the opthamologist on the average about 8 or 10 times per year due to a chronic eye disorder. He charges me 98 dollars for each visit to perform the following:

I wait in his reception area--on the average--60 to 90 minutes per visit.

He spends 5 to 7 minutes with me making a simple diagnosis and prescribing drops

Now, let me be clear on one fact here, and that is: this is not a criticism of my doctor (other than he makes me wait), but rather a indictment of a minority within our own ranks.

You see, this doctor's service is comparable to a typical visit for a busy chiropractor in a busy chiropractic office. That is to say, what I'm critical of is those chiropractors among us who are willing to reduce our reimbursement value to 18 dollars, 22 dollars, 27 dollars, 32 dollars, or whatever the piddlyass figure is, and for whatever reason.

My question is this... when did our leadership decide that, after incurring 100 to 175 thousand dollars in student loan debt, and whilst maintaining 15 to 25 thousand dollars a month in commercial overhead, who is the genius that determined that our 7 minute docket of diagnosis and spinal adjusting is worth 22 dollars?

Can any one out there spell D E F A U L T ?

We were just discussing this as a group over the weekend at the CAO convention, particularly as it relates to billing for extraspinal and myofascial treatments. Dr. Marc Heller (Ashland) was the instructor and moderator, and the issue of the CPT code index specifying 15 minutes for segmental traction and 15 minutes of trigger point application came-up. As a consensus doctors were insulted that they could not charge for specific soft tissue work and other types of extraspinal corrections that fell well under this time barrier.

So whose telling the opthamologist that he has to scan my eyes for 15 minutes, or squirt drops in my eyes continuously for 15 minutes, are gouge me with the laser beam for 15 minutes to get an optimum treatment?

Those who are versed in the healing arts know that many treatments of enormous value are rendered in only a few minutes and sometimes seconds. So whose setting the guidelines?

Many treatment applications are most effective in smaller doses. Who on the CPT counsel decides how much segmental traction is optimum? No wonder we see so many exacerbations of acute discs as a result of RPT based table traction.

When are we going to start dictating and governing our own profession again? The IME's in Oregon took it away from us in 1990, but I contend it's time to take it back.

We deserve equal pay for the special value attributable to our service.

I hope you're right Uncle Vern that were in the midst of taking back our own governance once again!

scott s.

Re: MEDICARE> > > > > >> Listmates - My last response to Dr. Feinberg has been lost in chaos> >> somewhere. I'll try again....> >> > >> Our exclusion from MC reimbursement for the other services we are> >> required to or may clinically choose to perform is not from the AMA> >> or HCFA. It is from the dichotomy of our profession. The> >> philosophical mess we have between those of us whom wish to practice> >> as Chiropractic Physicians and those Chiropractors that wish us not> >> to. If the ACA were the only significant national organization, we> >> would eventually have more parity. I believe the MC mess started when> >> we finaly entered into the program in the 1970's and the "subluxation> >> only" camp kept us at only treating "subluxations" and treating with> >> only adjustments instead of the plethora of adjunctive treatments we> >> use. Thus, we find ouselves here, responsible in this State (as well> >> as most others)for the patient's welfare by DDX and treatment but not> >> having any reimbursement for it. Indeed, prior to the change in CPT> >> coding a few years ago, our adjustment code did not require ANY> >> documentation,and we were reimbursed appropriately for that minimal> >> level of service. Now MC requires documentation, examination,> >> diagnosis but does not pay for it. We have the dichotomy to blame. If> >> you feel similarly, join the ACA.> >> > >> P. Thille, D.C., FACO> >> Redmond, Oregon> >> > >> -- In @y..., " S. Feinberg" <feinberg@e...> wrote:> >>> Dr. Bob;> >>> > >>> You are right on target, again! Reimbursement to a medical doctor> >> for > >>> therapeutic procedures that take the time a chiropractor takes to> >> examine > >>> and treat a patient typically receive from third party payers as> >> much as > >>> 10-20 times the dollars that a chiropractor receives for similar> >> time, > >>> effort, and skill. A good example is the one I posted about my> >> experience > >>> with a couple of dermatologists. Actually, it isn't a very good> >> example > >>> since I would be embarrassed to put our level of skill and the> >> thoroughness > >>> of our exams and documentation on the same level as a> >> dermatologist. We> >>> can't even bill accurately to MC. If I see a new patient I have to> >> use the > >>> 98940 code instead of the 99203, even though I take a history and> >> perform > >>> an exam that 98940 doesn't come close to describing; yet 99203> >> brings no > >>> reimbursement at all. I think it is time for our profession to get> >> out of > >>> the back of the bus and take a seat at the lunch counter.> >>> > >>> S. Feinberg, D.C.> >>> > >>> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:> >>> > >>>> LISTMATES;> >>>> > >>>> > >>>> > >>>> UNHAPPY WITH MEDICARE ???????> >>>> > >>>> > >>>> > >>>> MEDICARE DOUBLE STANDARDS??????> >>>> > >>>> > >>>> > >>>> Bulletin 196 Apr 15, 02 has the rules we MUST follow for E> >> & M s on > >>>> page 40. Time consuming aren t they????> >>>> > >>>> > >>>> > >>>> Look on page 71 MC wants your comments!> >>>> > >>>> > >>>> > >>>> Everyone on this listserve should write to MC and complain about> >>>> the requirements they impose upon DCs, BUT DO NOT re-imburse us> >> for > >>>> these services they request.> >>>> > >>>> > >>>> > >>>> MC pays the other providers for E & Ms but not DCs.> >>>> > >>>> > >>>> > >>>> Uncle VERNE- Do you think the ACA should advocate a letter> >> writing > >>>> campaign on this subject?????> >>>> > >>>> > >>>> > >>>> DrBob> >>>> > >>>> W. Pfeiffer, DC,DABCO> >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>>

April 29, 2002

Hey, at the convention I made the comment that time based therapies had to be done for a certain length of time, but I may have been putting my foot in my mouth. I do not know where I got this idea, nor am I sure of the exact nature of the rules

I sure enjoyed the convention, and the warm reception for my presentation.

It was great to see all of you.

Marc

Marc Heller,DCmheller@...www.DrMarcHeller.com987 Siskiyou Blvd.Ashland, OR 97520541-482-0625

Re: We deserve equal pay for the special value attributable to our service;Excellent points, all. I recall, though I can't recall from where, that the 15 minute designation on therapies in the CPT code book is based on the first 15 minutes, or any part thereof; not that the therapy has to last a full 15 minutes. There is coding if the therapy goes beyond that. Does anyone have a reference on this issue? So, if the 15 minute rule goes for things like vertebral distraction, and ultrasound, why don't we have to crank on C2 for 15 minutes to get paid? Les Shephard, DC wrote:

y, Good idea, but it might be more practical for each of us just to come-up with our own isolated cases. Here's one for you... I go to the opthamologist on the average about 8 or 10 times per year due to a chronic eye disorder. He charges me 98 dollars for each visit to perform the following:

I wait in his reception area--on the average--60 to 90 minutes per visit.

He spends 5 to 7 minutes with me making a simple diagnosis and prescribing drops Now, let me be clear on one fact here, and that is: this is not a criticism of my doctor (other than he makes me wait), but rather a indictment of a minority within our own ranks. You see, this doctor's service is comparable to a typical visit for a busy chiropractor in a busy chiropractic office. That is to say, what I'm critical of is those chiropractors among us who are willing to reduce our reimbursement value to 18 dollars, 22 dollars, 27 dollars, 32 dollars, or whatever the piddlyass figure is, and for whatever reason. My question is this... when did our leadership decide that, after incurring 100 to 175 thousand dollars in student loan debt, and whilst maintaining 15 to 25 thousand dollars a month in commercial overhead, who is the genius that determined that our 7 minute docket of diagnosis and spinal adjusting is worth 22 dollars? Can any one out there spell D E F A U L T ? We were just discussing this as a group over the weekend at the CAO convention, particularly as it relates to billing for extraspinal and myofascial treatments. Dr. Marc Heller (Ashland) was the instructor and moderator, and the issue of the CPT code index specifying 15 minutes for segmental traction and 15 minutes of trigger point application came-up. As a consensus doctors were insulted that they could not charge for specific soft tissue work and other types of extraspinal corrections that fell well under this time barrier. So whose telling the opthamologist that he has to scan my eyes for 15 minutes, or squirt drops in my eyes continuously for 15 minutes, are gouge me with the laser beam for 15 minutes to get an optimum treatment? Those who are versed in the healing arts know that many treatments of enormous value are rendered in only a few minutes and sometimes seconds. So whose setting the guidelines? Many treatment applications are most effective in smaller doses. Who on the CPT counsel decides how much segmental traction is optimum? No wonder we see so many exacerbations of acute discs as a result of RPT based table traction. When are we going to start dictating and governing our own profession again? The IME's in Oregon took it away from us in 1990, but I contend it's time to take it back. We deserve equal pay for the special value attributable to our service. I hope you're right Uncle Vern that were in the midst of taking back our own governance once again! scott s. Re: MEDICARE> > > > > >> Listmates - My last response to Dr. Feinberg has been lost in chaos> >> somewhere. I'll try again....> >> > >> Our exclusion from MC reimbursement for the other services we are> >> required to or may clinically choose to perform is not from the AMA> >> or HCFA. It is from the dichotomy of our profession. The> >> philosophical mess we have between those of us whom wish to practice> >> as Chiropractic Physicians and those Chiropractors that wish us not> >> to. If the ACA were the only significant national organization, we> >> would eventually have more parity. I believe the MC mess started when> >> we finaly entered into the program in the 1970's and the "subluxation> >> only" camp kept us at only treating "subluxations" and treating with> >> only adjustments instead of the plethora of adjunctive treatments we> >> use. Thus, we find ouselves here, responsible in this State (as well> >> as most others)for the patient's welfare by DDX and treatment but not> >> having any reimbursement for it. Indeed, prior to the change in CPT> >> coding a few years ago, our adjustment code did not require ANY> >> documentation,and we were reimbursed appropriately for that minimal> >> level of service. Now MC requires documentation, examination,> >> diagnosis but does not pay for it. We have the dichotomy to blame. If> >> you feel similarly, join the ACA.> >> > >> P. Thille, D.C., FACO> >> Redmond, Oregon> >> > >> -- In @y..., " S. Feinberg" <feinberg@e...> wrote:> >>> Dr. Bob;> >>> > >>> You are right on target, again! Reimbursement to a medical doctor> >> for > >>> therapeutic procedures that take the time a chiropractor takes to> >> examine > >>> and treat a patient typically receive from third party payers as> >> much as > >>> 10-20 times the dollars that a chiropractor receives for similar> >> time, > >>> effort, and skill. A good example is the one I posted about my> >> experience > >>> with a couple of dermatologists. Actually, it isn't a very good> >> example > >>> since I would be embarrassed to put our level of skill and the> >> thoroughness > >>> of our exams and documentation on the same level as a> >> dermatologist. We> >>> can't even bill accurately to MC. If I see a new patient I have to> >> use the > >>> 98940 code instead of the 99203, even though I take a history and> >> perform > >>> an exam that 98940 doesn't come close to describing; yet 99203> >> brings no > >>> reimbursement at all. I think it is time for our profession to get> >> out of > >>> the back of the bus and take a seat at the lunch counter.> >>> > >>> S. Feinberg, D.C.> >>> > >>> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:> >>> > >>>> LISTMATES;> >>>> > >>>> > >>>> > >>>> UNHAPPY WITH MEDICARE ???????> >>>> > >>>> > >>>> > >>>> MEDICARE DOUBLE STANDARDS??????> >>>> > >>>> > >>>> > >>>> Bulletin 196 Apr 15, 02 has the rules we MUST follow for E> >> & M s on > >>>> page 40. Time consuming aren t they????> >>>> > >>>> > >>>> > >>>> Look on page 71 MC wants your comments!> >>>> > >>>> > >>>> > >>>> Everyone on this listserve should write to MC and complain about> >>>> the requirements they impose upon DCs, BUT DO NOT re-imburse us> >> for > >>>> these services they request.> >>>> > >>>> > >>>> > >>>> MC pays the other providers for E & Ms but not DCs.> >>>> > >>>> > >>>> > >>>> Uncle VERNE- Do you think the ACA should advocate a letter> >> writing > >>>> campaign on this subject?????> >>>> > >>>> > >>>> > >>>> DrBob> >>>> > >>>> W. Pfeiffer, DC,DABCO> >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>>

April 30, 2002

RE: time-dependent coding

You can use the -52 modifier, which represents a reduced time-dependent

service. I have this for my clients on the SOAP notes as a procedure key,

listed as 5 minutes. Bill for 1/3 of the RVU for this service, and list it on

the HCFA as such. This is closer to what most DCs are actually doing, rather

than a nonspecific regional or full-body ST treatment. Notes should be a

check box for the type of physical medicine (i.e. TrP), and location (i.e. L

piriformis)

The insurers that don't routinely deny, bundle, or downcode physical medicine

codes (if there are any left!) will pay this service. It's way cheaper than

PT if anyone wants to objectively compare.

Roy Steinberg DC

April 30, 2002

;

Excellent points, all. I recall, though I can't recall from where,

that the 15 minute designation on therapies in the CPT code book is based

on the first 15 minutes, or any part thereof; not that the therapy has to

last a full 15 minutes. There is coding if the therapy goes beyond

that. Does anyone have a reference on this issue? So, if the

15 minute rule goes for things like vertebral distraction, and

ultrasound, why don't we have to crank on C2 for 15 minutes to get

paid?

Les

Shephard, DC wrote:

y,

Good idea, but it might be more practical for

each of us just to come-up with our own isolated cases. Here's one

for you...

I go to the opthamologist on the average about

8 or 10 times per year due to a chronic eye disorder. He charges me

98 dollars for each visit to perform the following:

I wait in his reception area--on the average--60 to 90 minutes per

visit.

He spends 5 to 7 minutes with me making a simple diagnosis and

prescribing drops

Now, let me be clear on one fact here, and

that is: this is not a criticism of my doctor (other than he makes me

wait), but rather a indictment of a minority within our own

ranks.

You see, this doctor's service is comparable to

a typical visit for a busy chiropractor in a busy chiropractic

office. That is to say, what I'm critical of is those chiropractors

among us who are willing to reduce our reimbursement value to 18 dollars,

22 dollars, 27 dollars, 32 dollars, or whatever the piddlyass figure is,

and for whatever reason.

My question is this... when did our leadership

decide that, after incurring 100 to 175 thousand dollars in student loan

debt, and whilst maintaining 15 to 25 thousand dollars a month in

commercial overhead, who is the genius that determined that our 7 minute

docket of diagnosis and spinal adjusting is worth 22 dollars?

Can any one out there spell D

E F A U L T ?

We were just discussing this as a group over

the weekend at the CAO convention, particularly as it relates to billing

for extraspinal and myofascial treatments. Dr. Marc Heller

(Ashland) was the instructor and moderator, and the issue of the CPT code

index specifying 15 minutes for segmental traction and 15 minutes of

trigger point application came-up. As a consensus doctors were

insulted that they could not charge for specific soft tissue work and

other types of extraspinal corrections that fell well under this time

barrier.

So whose telling the opthamologist that he has

to scan my eyes for 15 minutes, or squirt drops in my eyes continuously

for 15 minutes, are gouge me with the laser beam for 15 minutes to get an

optimum treatment?

Those who are versed in the healing arts know

that many treatments of enormous value are rendered in only a few minutes

and sometimes seconds. So whose setting the guidelines?

Many treatment applications are most effective

in smaller doses. Who on the CPT counsel decides how much segmental

traction is optimum? No wonder we see so many exacerbations of

acute discs as a result of RPT based table traction.

When are we going to start dictating and

governing our own profession again? The IME's in Oregon took it

away from us in 1990, but I contend it's time to take it

back.

We deserve equal pay for the special value

attributable to our service.

I hope you're right Uncle Vern that were in the

midst of taking back our own governance once again!

scott s.

Re: MEDICARE

> >

> >> Listmates - My last response to Dr. Feinberg has been lost in chaos

> >> somewhere. I'll try again....

> >>

> >> Our exclusion from MC reimbursement for the other services we are

> >> required to or may clinically choose to perform is not from the AMA

> >> or HCFA. It is from the dichotomy of our profession. The

> >> philosophical mess we have between those of us whom wish to practice

> >> as Chiropractic Physicians and those Chiropractors that wish us not

> >> to. If the ACA were the only significant national organization, we

> >> would eventually have more parity. I believe the MC mess started when

> >> we finaly entered into the program in the 1970's and the " subluxation

> >> only " camp kept us at only treating " subluxations " and treating with

> >> only adjustments instead of the plethora of adjunctive treatments we

> >> use. Thus, we find ouselves here, responsible in this State (as well

> >> as most others)for the patient's welfare by DDX and treatment but not

> >> having any reimbursement for it. Indeed, prior to the change in CPT

> >> coding a few years ago, our adjustment code did not require ANY

> >> documentation,and we were reimbursed appropriately for that minimal

> >> level of service. Now MC requires documentation, examination,

> >> diagnosis but does not pay for it. We have the dichotomy to blame. If

> >> you feel similarly, join the ACA.

> >>

> >> P. Thille, D.C., FACO

> >> Redmond, Oregon

> >>

> >> -- In @y..., " S. Feinberg " <feinberg@e...> wrote:

> >>> Dr. Bob;

> >>>

> >>> You are right on target, again! Reimbursement to a medical doctor

> >> for

> >>> therapeutic procedures that take the time a chiropractor takes to

> >> examine

> >>> and treat a patient typically receive from third party payers as

> >> much as

> >>> 10-20 times the dollars that a chiropractor receives for similar

> >> time,

> >>> effort, and skill. A good example is the one I posted about my

> >> experience

> >>> with a couple of dermatologists. Actually, it isn't a very good

> >> example

> >>> since I would be embarrassed to put our level of skill and the

> >> thoroughness

> >>> of our exams and documentation on the same level as a

> >> dermatologist. We

> >>> can't even bill accurately to MC. If I see a new patient I have to

> >> use the

> >>> 98940 code instead of the 99203, even though I take a history and

> >> perform

> >>> an exam that 98940 doesn't come close to describing; yet 99203

> >> brings no

> >>> reimbursement at all. I think it is time for our profession to get

> >> out of

> >>> the back of the bus and take a seat at the lunch counter.

> >>>

> >>> S. Feinberg, D.C.

> >>>

> >>> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

> >>>

> >>>> LISTMATES;

> >>>>

> >>>> UNHAPPY WITH MEDICARE ???????

> >>>>

> >>>> MEDICARE DOUBLE STANDARDS??????

> >>>>

> >>>> Bulletin 196 Apr 15, 02 has the rules we MUST follow for E

> >> & M s on

> >>>> page 40. Time consuming aren t they????

> >>>>

> >>>> Look on page 71 MC wants your comments!

> >>>>

> >>>> Everyone on this listserve should write to MC and complain about

> >>>> the requirements they impose upon DCs, BUT DO NOT re-imburse us

> >> for

> >>>> these services they request.

> >>>>

> >>>> MC pays the other providers for E & Ms but not DCs.

> >>>>

> >>>> Uncle VERNE- Do you think the ACA should advocate a letter

> >> writing

> >>>> campaign on this subject?????

> >>>>

> >>>> DrBob

> >>>>

> >>>> W. Pfeiffer, DC,DABCO

> >>>>

April 30, 2002

I have a friend who had to have several prostate massages. As I recall, he

would have gladly paid for the therapy if insurance refused to reimburse

because the doctor did not massage for the FULL 15 MINUTES!

--

Dr. Abrahamson

> From: " S. Feinberg " <feinberg@...>

> Date: Tue, 30 Apr 2002 08:22:24 -0700

> " Dr. Shephard, DC " <shep@...>, " Vern Saboe DC "

> <las@...>, < >, " mthille " <mpt@...>,

> " Abrahamson " <drscott@...>

> Subject: Re: We deserve equal pay for the special value

> attributable to our service

>

> ;

> Excellent points, all. I recall, though I can't recall from where, that

> the 15 minute designation on therapies in the CPT code book is based on the

> first 15 minutes, or any part thereof; not that the therapy has to last a

> full 15 minutes. There is coding if the therapy goes beyond that. Does

> anyone have a reference on this issue? So, if the 15 minute rule goes for

> things like vertebral distraction, and ultrasound, why don't we have to

> crank on C2 for 15 minutes to get paid?

> Les

>

> Shephard, DC wrote:

>> y,

>>

>> Good idea, but it might be more practical for each of us just to come-up

>> with our own isolated cases. Here's one for you...

>>

>> I go to the opthamologist on the average about 8 or 10 times per year due

>> to a chronic eye disorder. He charges me 98 dollars for each visit to

>> perform the following:

>> * I wait in his reception area--on the average--60 to 90 minutes per

>> visit.

>> * He spends 5 to 7 minutes with me making a simple diagnosis and

>> prescribing drops

>> Now, let me be clear on one fact here, and that is: this is not a

>> criticism of my doctor (other than he makes me wait), but rather a

>> indictment of a minority within our own ranks.

>>

>> You see, this doctor's service is comparable to a typical visit for a busy

>> chiropractor in a busy chiropractic office. That is to say, what I'm

>> critical of is those chiropractors among us who are willing to reduce our

>> reimbursement value to 18 dollars, 22 dollars, 27 dollars, 32 dollars, or

>> whatever the piddlyass figure is, and for whatever reason.

>>

>> My question is this... when did our leadership decide that, after

>> incurring 100 to 175 thousand dollars in student loan debt, and whilst

>> maintaining 15 to 25 thousand dollars a month in commercial overhead, who

>> is the genius that determined that our 7 minute docket of diagnosis and

>> spinal adjusting is worth 22 dollars?

>>

>> Can any one out there spell D E F A U L T ?

>>

>> We were just discussing this as a group over the weekend at the CAO

>> convention, particularly as it relates to billing for extraspinal and

>> myofascial treatments. Dr. Marc Heller (Ashland) was the instructor and

>> moderator, and the issue of the CPT code index specifying 15 minutes for

>> segmental traction and 15 minutes of trigger point application

>> came-up. As a consensus doctors were insulted that they could not charge

>> for specific soft tissue work and other types of extraspinal corrections

>> that fell well under this time barrier.

>>

>> So whose telling the opthamologist that he has to scan my eyes for 15

>> minutes, or squirt drops in my eyes continuously for 15 minutes, are gouge

>> me with the laser beam for 15 minutes to get an optimum treatment?

>>

>> Those who are versed in the healing arts know that many treatments of

>> enormous value are rendered in only a few minutes and sometimes

>> seconds. So whose setting the guidelines?

>>

>> Many treatment applications are most effective in smaller doses. Who on

>> the CPT counsel decides how much segmental traction is optimum? No wonder

>> we see so many exacerbations of acute discs as a result of RPT based table

>> traction.

>>

>> When are we going to start dictating and governing our own profession

>> again? The IME's in Oregon took it away from us in 1990, but I contend

>> it's time to take it back.

>>

>> We deserve equal pay for the special value attributable to our service.

>>

>> I hope you're right Uncle Vern that were in the midst of taking back our

>> own governance once again!

>>

>> scott s.

>>

>> Re: MEDICARE

>>>>

>>>>> Listmates - My last response to Dr. Feinberg has been lost in chaos

>>>>> somewhere. I'll try again....

>>>>>

>>>>> Our exclusion from MC reimbursement for the other services we are

>>>>> required to or may clinically choose to perform is not from the AMA

>>>>> or HCFA. It is from the dichotomy of our profession. The

>>>>> philosophical mess we have between those of us whom wish to practice

>>>>> as Chiropractic Physicians and those Chiropractors that wish us not

>>>>> to. If the ACA were the only significant national organization, we

>>>>> would eventually have more parity. I believe the MC mess started when

>>>>> we finaly entered into the program in the 1970's and the " subluxation

>>>>> only " camp kept us at only treating " subluxations " and treating with

>>>>> only adjustments instead of the plethora of adjunctive treatments we

>>>>> use. Thus, we find ouselves here, responsible in this State (as well

>>>>> as most others)for the patient's welfare by DDX and treatment but not

>>>>> having any reimbursement for it. Indeed, prior to the change in CPT

>>>>> coding a few years ago, our adjustment code did not require ANY

>>>>> documentation,and we were reimbursed appropriately for that minimal

>>>>> level of service. Now MC requires documentation, examination,

>>>>> diagnosis but does not pay for it. We have the dichotomy to blame. If

>>>>> you feel similarly, join the ACA.

>>>>>

>>>>> P. Thille, D.C., FACO

>>>>> Redmond, Oregon

>>>>>

>>>>> -- In <mailto:@y>@y..., " S. Feinberg "

>> <<mailto:feinberg@e>feinberg@e...> wrote:

>>>>>> Dr. Bob;

>>>>>>

>>>>>> You are right on target, again! Reimbursement to a medical doctor

>>>>> for

>>>>>> therapeutic procedures that take the time a chiropractor takes to

>>>>> examine

>>>>>> and treat a patient typically receive from third party payers as

>>>>> much as

>>>>>> 10-20 times the dollars that a chiropractor receives for similar

>>>>> time,

>>>>>> effort, and skill. A good example is the one I posted about my

>>>>> experience

>>>>>> with a couple of dermatologists. Actually, it isn't a very good

>>>>> example

>>>>>> since I would be embarrassed to put our level of skill and the

>>>>> thoroughness

>>>>>> of our exams and documentation on the same level as a

>>>>> dermatologist. We

>>>>>> can't even bill accurately to MC. If I see a new patient I have to

>>>>> use the

>>>>>> 98940 code instead of the 99203, even though I take a history and

>>>>> perform

>>>>>> an exam that 98940 doesn't come close to describing; yet 99203

>>>>> brings no

>>>>>> reimbursement at all. I think it is time for our profession to get

>>>>> out of

>>>>>> the back of the bus and take a seat at the lunch counter.

>>>>>>

>>>>>> S. Feinberg, D.C.

>>>>>>

>>>>>> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

>>>>>>

>>>>>>> LISTMATES;

>>>>>>>

>>>>>>> UNHAPPY WITH MEDICARE ???????

>>>>>>>

>>>>>>> MEDICARE DOUBLE STANDARDS??????

>>>>>>>

>>>>>>> Bulletin 196 Apr 15, 02 has the rules we MUST follow for E

>>>>> & M s on

>>>>>>> page 40. Time consuming aren t they????

>>>>>>>

>>>>>>> Look on page 71 MC wants your comments!

>>>>>>>

>>>>>>> Everyone on this listserve should write to MC and complain about

>>>>>>> the requirements they impose upon DCs, BUT DO NOT re-imburse us

>>>>> for

>>>>>>> these services they request.

>>>>>>>

>>>>>>> MC pays the other providers for E & Ms but not DCs.

>>>>>>>

>>>>>>> Uncle VERNE- Do you think the ACA should advocate a letter

>>>>> writing

>>>>>>> campaign on this subject?????

>>>>>>>

>>>>>>> DrBob

>>>>>>>

>>>>>>> W. Pfeiffer, DC,DABCO

>>>>>>>

April 30, 2002

To all, I have had several discussion with the OMA and the CPT codes facilitators. I have asked for documentation regarding this "15 minute" coding time line. They have not yet supplied me with the documentation. According to the OMA and CPT people the interpretation or intent of the "15 minute" time line was to allow doctors to be able to charge more for any one service by allowing them to charge after every 15 minute interval. The 15 minute interval was for billing purposes not treatment/care purposes.

I believe you will be within the standards of billing practices if you interrupt the time sensitive codes as UP TO 15 MINUTES. In other words one minute to fifteen minutes is your first billing code, sixteen minutes to thirty minutes is your next billing code and so on.

Fox

Re: MEDICARE> > > > > >> Listmates - My last response to Dr. Feinberg has been lost in chaos> >> somewhere. I'll try again....> >> > >> Our exclusion from MC reimbursement for the other services we are> >> required to or may clinically choose to perform is not from the AMA> >> or HCFA. It is from the dichotomy of our profession. The> >> philosophical mess we have between those of us whom wish to practice> >> as Chiropractic Physicians and those Chiropractors that wish us not> >> to. If the ACA were the only significant national organization, we> >> would eventually have more parity. I believe the MC mess started when> >> we finaly entered into the program in the 1970's and the "subluxation> >> only" camp kept us at only treating "subluxations" and treating with> >> only adjustments instead of the plethora of adjunctive treatments we> >> use. Thus, we find ouselves here, responsible in this State (as well> >> as most others)for the patient's welfare by DDX and treatment but not> >> having any reimbursement for it. Indeed, prior to the change in CPT> >> coding a few years ago, our adjustment code did not require ANY> >> documentation,and we were reimbursed appropriately for that minimal> >> level of service. Now MC requires documentation, examination,> >> diagnosis but does not pay for it. We have the dichotomy to blame. If> >> you feel similarly, join the ACA.> >> > >> P. Thille, D.C., FACO> >> Redmond, Oregon> >> > >> -- In @y..., " S. Feinberg" <feinberg@e...> wrote:> >>> Dr. Bob;> >>> > >>> You are right on target, again! Reimbursement to a medical doctor> >> for > >>> therapeutic procedures that take the time a chiropractor takes to> >> examine > >>> and treat a patient typically receive from third party payers as> >> much as > >>> 10-20 times the dollars that a chiropractor receives for similar> >> time, > >>> effort, and skill. A good example is the one I posted about my> >> experience > >>> with a couple of dermatologists. Actually, it isn't a very good> >> example > >>> since I would be embarrassed to put our level of skill and the> >> thoroughness > >>> of our exams and documentation on the same level as a> >> dermatologist. We> >>> can't even bill accurately to MC. If I see a new patient I have to> >> use the > >>> 98940 code instead of the 99203, even though I take a history and> >> perform > >>> an exam that 98940 doesn't come close to describing; yet 99203> >> brings no > >>> reimbursement at all. I think it is time for our profession to get> >> out of > >>> the back of the bus and take a seat at the lunch counter.> >>> > >>> S. Feinberg, D.C.> >>> > >>> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:> >>> > >>>> LISTMATES;> >>>> > >>>> > >>>> > >>>> UNHAPPY WITH MEDICARE ???????> >>>> > >>>> > >>>> > >>>> MEDICARE DOUBLE STANDARDS??????> >>>> > >>>> > >>>> > >>>> Bulletin 196 Apr 15, 02 has the rules we MUST follow for E> >> & M s on > >>>> page 40. Time consuming aren t they????> >>>> > >>>> > >>>> > >>>> Look on page 71 MC wants your comments!> >>>> > >>>> > >>>> > >>>> Everyone on this listserve should write to MC and complain about> >>>> the requirements they impose upon DCs, BUT DO NOT re-imburse us> >> for > >>>> these services they request.> >>>> > >>>> > >>>> > >>>> MC pays the other providers for E & Ms but not DCs.> >>>> > >>>> > >>>> > >>>> Uncle VERNE- Do you think the ACA should advocate a letter> >> writing > >>>> campaign on this subject?????> >>>> > >>>> > >>>> > >>>> DrBob> >>>> > >>>> W. Pfeiffer, DC,DABCO> >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>>

May 1, 2002

Don;

Thanks for the research into this. Do you know of any specific

reference we can get hold of that says specifically that this is the way

the CPT description should be interpreted?

Les

At 10:28 AM 4/30/02 -0700, Dr. Don Fox wrote:

To all, I

have had several discussion with the OMA and the CPT codes

facilitators. I have asked for documentation regarding this

" 15 minute " coding time line. They have not yet supplied

me with the documentation. According to the OMA and CPT people the

interpretation or intent of the " 15 minute " time line was to

allow doctors to be able to charge more for any one service by allowing

them to charge after every 15 minute interval. The 15 minute

interval was for billing purposes not treatment/care purposes.

I believe you will be within the standards of

billing practices if you interrupt the time sensitive codes as UP TO 15

MINUTES. In other words one minute to fifteen minutes is your first

billing code, sixteen minutes to thirty minutes is your next billing code

and so on.