Serving Chiropractors and Their Patients

Practical Use of Telehealth by D.C.’s

The coronavirus pandemic dramatically changed the means by which individuals chose to seek health care services.  With the March 20, 2020 emergency guidlines issued by the CMS, an unprecidented wave of new wiavers and rules led to the accelerated use of virtual health visits or “telehealth”.  An isightful article published with the National Institute of Health on the growth of chiropractic telehealth in California; including a discussion of approaches and challenges, is available HERE.  Although this means of bringing together patients with their providers has been utilized extensivley by the medical community, chiropractors have not yet commonly embraced this means of consultation with patients.  This article addresses the practical aspects of implementing chiropractic telehelath as it relates to the types of services offered to patients and insurance billing practices.

It appears from anecdotal evidence that few chiropractors in Wisconsin are actively using telehealth methods to provide services to patients. This is unfortunate from the perspective of  patient safety, convenience of meeting, and efficiency of service delivery.  Although chiropractors cannot obviously perform traditional examinations or adjustments by virtual connection, there are modalities of chiropractic services which can be preformed by remote communication.  Although neither the state’s examining board nor either of the professional associations have provided any guidlines on the parameters of this care, a useful video was issued by the Illinois Chiropractic Organization on areas of chiropractic teleheath.  See HERE. Considering all the modalities of care offered by D.C.’s in this state, it would be practical for a doctor to consider offering the following telehealth services: 

  • Exercise Therapy – Advice on flexibility, strengthening, balance and other kinesthetic directions; including rehabilitative features.  Weights, bands, or heavier household items can be used by the patient while at their home.
  • Ergonomic Advice – Advice on the proper use of vocational devices, risk avoidance, posture and functionality in activities of daily living; such as computer use, proper lifting of objects, and posture issues with common movements.
  • Nutritional Counseling – Advice with respect to diet, stress reduction, vitamins and supplement use.
  • Counseling and Monitoring of supportive therapies – Advice with regard to taping, supportive devices, exercise balls, posture devices, and other forms of soft tissue management devices/substances, including topical applications which can be done away from the office. 

Besides obtaining “subjective” information from the patient,  doctors can perform many aspects of a musculoskeletal exam by observing the patient’s posture, range of motion, skin swelling/discoleration, and performance during some common orthopeodic tests.  For an example of the implementation of these telehealth features, one can view the promotion of telehealth offered by an out-of-state chiropractic office, Morrison Chiropractic.  See this practical application HERE.

Beyond implementation, providers will be concerned with receiving compensation for telehealth services.  In this regard, NCMIC has offered a general overview of coding practices which can be found HERE.  In this area of the country, three prominent health insurance companies have indicated that chiropractic telehealth can be billed.  Those insurers are Blue Cross/Blue Shield, Aetna, and United Healthcare.  An insightful article on chiropractic billing with United Healthcare can be found HERE.  Given this state’s broad reaching “equality statute” providing billing parity between chiropractic and other healthcare professions, legal arguments can be made that insurers should recognize and promptly pay the claims for chiropractic telehealth in a fashion comprable to that paid to other providers. Questions relating to billing can be addressed by contributors at this site.  Additionally, before engaging in this new means of health care delivery, chiropractors must be aware of significant legal and regulatory requirements addressed in our previous blog.