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Medicare LCD Update
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On November 6 , 2017 the newest Local Coverage Determination (LCD): Chiropractic Services through CGS will take affect.  Here is a link to the newest version. 


There are 2 main changes to take note of:

  1. The first is in regard to diagnosis.  Medicare continues to require a Primary subluxation/segmental dysfunction diagnosis. M99.01, M99.02, M99.03, M99.04, M99.05 continue to be acceptable in the primary diagnosis position.  They have removed the requirement of the secondary/supporting diagnosis - what was previously listed in Group 2.  However, it is important to note that we are allowed to provide a secondary diagnosis if it is appropriate to a patient's case.  In fact, these secondary diagnoses can help to describe complicating factors that may exist which could impact the duration of patient care and or patient's response to care.  In many cases, it may be encouraged to use a secondary or tertiary diagnosis to better tell the story of the patient's condition.   If you decide to use a secondary diagnosis, you are no longer limited to a subset of diagnoses, but instead can choose the appropriate diagnosis from the entire ICD-10

  2. The second change is in regard to documentation.  Under Documentation Requirements for Subsequent Visits there are now 4 requirements instead of 3.  The 4th one states: "4. Documentation of how the day’s treatment fits within the plan of care (e.g. “visit 4 of planned 7 treatments”) and any way the treatment plan is being changed.

Please visit the link above to view the LCD for chiropractic in its entirety.

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