When a patient presents to Healing Hands Wellness Center in St Paul Minneapolis for treatment and correction of neck pain, a carefully defined treatment plan is established from day one. A professional care plan establishes medical necessity for chiropractic manipulative spinal adjustments, therapeutic modalities and procedures to be utilized to fix neck pain.
The typical chiropractic treatment plan follows a six item plan of implementation. These steps are items: 1-history, 2-examination, 3-diagnosis, 4-patient clinical goals, 5-list of services/rationale and 6-schedule of care.
A patient’s history of neck pain can be graded at four levels: 99210, 99202, 99203, and 99204. The example of a 99201 history is problem focused, as in mild morning neck pain with no prior history of trauma, use of medications and of an immediate same day onset.
The typical history/examination is a detailed one (99203) in which there is a review of the patient’s explanation of 1 chief complaint and 12 identified elements [for example: 3 vital signs equate to 1 finding, General appearance, brief mental assessment, palpatory tenderness of the neck, ranges of motion in cervical spine, assess for subluxations of the neck and lower back, assessment of muscle tone/strength of the cervical spine, deep tendon reflexes, ambulatory upper extremity arm motions, shoulder girdle posture and skin are reviewed].
The next two steps in a care plan for actively correcting cervical pain and stiffness would be making a definitive diagnosis, along with a highly specific description of services to be provided to render treatment for any such neck pain and stiffness. A hypothetical set of diagnosis for neck pain and stiffness would be: Cervical sprain strain [847.0], cervical subluxations [739.1] neck muscle spasms [728.85] and cervical pain [723.1].
The following example of procedural services are considered in a comprehensive care plan to reduce cervical spine symptomatology before or after the chiropractor makes mechanical adjustments to the segments of the cervical spine to regain their normal alignment and motion. All the following procedures may be reasonable and medically necessary to reduce subluxation based impairment in the neck:
1-Ice or Heat packs: 97101: Cold: vasoconstriction, analgesia and reduce nerve inflammation: Hot: calming effect, relax tissues, or reduce spasm of the neck muscles
2-Mechanical Traction: 97012: separates and stretches the spinal segments, promote gliding of facet joints, promote adequate joint hydration in the cervical spine
3-Therapeutic exercises: 97110: used to increase flexibility, endurance and strength: Therapeutic exercises to the cervical spine in order to increase ranges of spinal motion and associated joint strength and stability. The exercises also improve normal tonicity, reduce restrictions, improve muscle flexibility and resilience, as well as reduce spasms and or stiffness.
4-Neuromuscular re-education of movement: 97112: this procedure is used to improve balance, coordination, kinesthetic sense and proprioception:
5-Manual therapy techniques: 97140: mobilization, manual lymphatic drainage, or manual traction from 1 to 15 minutes used to effect positive change of cervical articular alignment and stability, as well as the neural and vascular systems.
6-Chiropractic spinal adjustments: 98943: to correct subluxations within the neck to improve neurophysiological function of the cervical spine.
Finally, each patient with neck symptoms of pain and stiffness is given personalized education in managing his spinal condition at home or at work to reduce the risk of incurring a secondary injury. This will include proper instruction on correct body posture when lifting, bending or changing body positions during sequential activities.
The diagnosis, prognosis and proposed care plan, alternative care options, care risks and benefits were explained to the patient and they were given an opportunity to ask questions. The patient consented to begin primary chiropractic management for spinal health care.
Move Well and Stay Healthy
Dr Robert C Slater BA, MSc, CME, DC
635 Cleveland Ave S #1
St Paul Minnesota