b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE UpdateMedicareQ&AMedicare Update Documenting OUR HEALTHthe Subluxation forBy Dr. Richard C. HealyMedicare(Series 1 of 3)ANJC Medicare ConsultantPatient Informationn Name of beneficiary and date of service on all documentationSubluxationn Subluxation demonstrated by X-ray, date of X-ray: ______________ A CT scan and/or MRI is acceptable evidence if subluxation of spine is demonstratedDocumentation of chiropractors review of the X-ray/MRI/CT, noting level of subluxationThe X-ray must have been taken reasonably close to (within 12 months prior or 3 months following) the beginningof treatment. In certain cases of chronic subluxation (for example, scoliosis), an older X-ray may be accepted if thebeneficiarys health record indicates the condition has existed longer than 12 months and there is a reasonable basis for concluding that the condition is permanent.OR n Subluxation demonstrated by physical examination (Pain, Asymmetry/misalignment, Range of motion abnormality,Tissue tone changes [P.A.R.T.]; at least 2 elements, 1 of which must be A. or R.) n Include dated documentation of initial evaluationn Primary diagnosis of subluxation (including level of subluxation) n Documentation of presence or absence of subluxation must be included for every visit n Any documentation supporting medical necessitySource: CMS Medicare Learning News: Medicare Documentation Job Aid for Doctors of ChiropracticRichard C. Healy, DC, CCSP, is the treasurer and Medicare consultant to the ANJC.A New Jersey Medicare Carrier Advisor Committee delegate and a Certified Chiropractic Insurance Consultant, Dr. Healy is in private practice in Dumont.Reasons for Referral prescribed combined hormonal contraceptives (CHCs) containing estradiol. Both are independent risk factors forDiagnostic uncertainty stroke in young women. In addition, a change from migraineProgressive worsening of symptoms w/o aura to migraine w/aura after starting CHCs is a signalHA w/ motor weakness or CNS symptoms to stop immediately while progestogen-only contraception isNew HA that is severe/ different acceptable with any type or subtype of migraine. HormoneFirsttime cluster HA or trigeminal neuralgia HA worsens with activity replacement therapy is not contraindicated in migraine w/ orConcerns for secondary HA w/o aura in post-menopausal women.HA with stiff neck, fever, personality change Doctors, now you know, when a patient presents with a HA, if they should stay or if they should go. Table 2REFERENCES:HA management involves a true multimodal approach. CMTAskarpour M, Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients, BMC Research Notes, to the areas of joint restriction within the entire spine andVol13, 2020TMJ as well as soft tissue work for trigger points or myofas- Rezaeian T, The Impact of Soft Tissue Techniques in the Management of Migraine cial restrictions are appropriate. Diet can be a factor whetherHeadache: A Randomized Controlled Trial, J of Chiro Med, Dec 2019food or chemical sensitivities are present or simply avoidingSteiner TJ, et al., Aids to management of headache disorders in primary care, J of extreme changes in blood sugar. Recently the MIND Diet hasHeadache and Pain (2019) shown benefit in migraine management and is a blend of theDonald DeFabio, DC, DACBSP, DACRB, DABCO, is in private DASH (high potassium foods) and Mediterranean diets. practice in Berkeley Heights where he hosts relevant rehab study Final caveat: Women migraineurs w/aura should not begroups for doctors looking to workshop together. www.njchiropractors.com I 15'