The first "National Chiropractic E & M Coding Conference" took place November 14-15, 1992 in Phoenix, Arizona. The conference attendees came to an initial agreement on clinical definitions for chiropractic E & M (Evaluation and Management) coding. While representatives from state associations across the country were invited, the turnout was limited to the following:
John Geary, D.C. -- Chairman, Arizona Association of Chiropractic Education Committee
Veronica Gutierrez, D.C. -- Leader of the World Chiropractic Alliance (WCA) Managed Health Care Committee
Thomas LaBrot, D.C. -- Arizona E & M Committee and member College of Chiropractic Consultants
Terry Peterson, D.C. -- Writer/contributor to Part 3 of the National Board Clinical Competency, member Arizona E & M Code Committee
Terry Rondberg, D.C. -- President of the World Chiropractic Alliance
Dennis Semlow, D.C. -- Representing Parker Chiropractic Resource Foundation and Michigan Chiropractic Society Peer Review Committee
The conference was moderated by Mr. D.H. Leavitt, president of Continuing Education Coordinators. The conference was co-sponsored by Mr. Leavitt and the Arizona Association of Chiropractic.
The conference was designed to establish specific definitions and protocols for utilizing the three key components used in E & M code selection. The CPT-92 coding book which contains the health care industry guidelines does not include clinical definitions. Those definitions are left to the individual health care specialty to establish, because of the diversity of many health care providers.
The initial work recognized four levels of E & M reporting:
- Problem Focused
- Expanded Problem Focused
- Detailed
- Comprehensive
These titles were taken from the AMA's CPT Guidelines.
Interestingly enough, the following exception was made for examination: "Note: Straight Chiropractic will routinely NOT exceed the Expanded Problem Focused Level" (i.e., straight chiropractors will no routinely examine at the detailed or comprehensive levels).
This will have a great professional and financial impact on those who consider themselves "straight chiropractors" because it will customarily exclude them from utilizing the new codes that correspond to the higher service levels and payment levels. This, in essence, cuts the related diagnostic and income of "straight chiropractors" in half compared to their "nonstraight" counterparts.
This limitation on straight chiropractic came from Terry Rondberg, D.C., president of the WCA. The statement is apparently in keeping with the draft copy of the Wyndham Guidelines that Dr. Rondberg quoted from.
But not everyone at the conference agreed with the language limiting straight chiropractic. Dr. Semlow made this comment:
"I understand Dr. Rondberg's position from a philosophic basis, but I don't think from a practical application that all those who consider themselves "straight chiropractors" will be in agreement with this limitation in their choice of care for their patients. E & M codes aren't political, they are performance-based codes that explain the work done on a patient encounter."
The next E & M Coding Conference is planned for Thursday, January 14, 1993 in Las Vegas at the Parker School of Professional Success seminar. Greater participation is sought to allow adoption of these E & M code clinical definitions; they will be used nationally.
