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Chiropractic Research Review

Evaluation and Management Codes, Chiropractors and HICFA

Over the past two decades, the rate of growth in the cost of physician services has exceeded that of the economy in general. This trend has led payers, employers, government agencies and consumer advocates to more closely examine physician fees.

Pertinent to this article, the Health Care Financing Administration (HICFA), which manages Medicare, began using a new reimbursement system known as resource-based relative value scales (RBRVS). Based on the total amount of work performed in case management, practice costs and exposure risk, RBRVS were established for more than 50 medical specialties by HICFA in 1992. However, chiropractic was not one of the specialties evaluated, so variations in billing practices emerged. These issues prompted the authors of this paper to establish RBRVS for chiropractors in 1997.

The current study compared the results of work and time inputs from chiropractors with those reported by osteopathic and medical specialists. Data for chiropractic work and time reports were drawn from a national random sample of chiropractors as part of a 1997 workers compensation chiropractic fee schedule development project; medical and osteopathic inputs came from research conducted at Harvard University in 1990.

Results: Chiropractic inputs for evaluation and management services were similar to those reported by medical specialists and osteopaths; the range of variation between chiropractic work input and other specialties was also similar. Chiropractors reported greater work input for radiologic interpretation and lower work input for manipulation services.

The authors suggest that these results demonstrate that "from a policy perspective, there is no basis for restricting the use of E/M codes by chiropractors on grounds that they do not perform total work similar to their medical and osteopathic colleagues."

Hess JA, Mootz RD. Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers. Journal of Manipulative and Physiological Therapeutics, June 1999:22(5), pp280-291.
Reprints: (800) 453-4351 or (314) 453-4351

Chiropractic Research Review

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