Upholding Documentation and Coding Standards
I read with interest the article titled "Health Care Fraud: The Costly Deception" by Daniel Osborne in your Jan. 1, 2009 edition. It was an enjoyable read, but I would like to correct a statement that was made. On page 36, it reads, "Although CPT has been around for decades, there are no standards of education and training required of health care providers for the proper use of the codes, or insurers for what the codes mean." As a practitioner in Florida for the past 37 years, I can tell you that the Florida Board of Chiropractic Medicine requires six hours of coding, documentation and record-keeping every license renewal period. The doctor is scanned in and out of class for verification. I would imagine that other states have similar requirements as well.
The ACA and FCLB have both been instrumental in directing examining boards to mandate documentation education as part of their core CE. Additionally, the ACA has produced coding and documentation manuals for a number of years. Members of our coding and documentation committees have lectured around the country, providing valuable information on proper coding and documentation standards to hundreds of DCs. And the ACA has a chiropractor on both the AMA CPT Committee and the AMA RVS Update Committee (RUC), providing our profession with cutting-edge information in these areas.
In 1999, the ACA formed a working group with a number insurers - the Claims Solution Work Group. Meetings have taken place by teleconference and in person to discuss and address issues and concerns regarding proper coding and documentation. The ACA is well-aware of the challenges with regard to coding and documentation, and we are doing our very best to address them.
John Gentile, DC
Chairman, American Chiropractic Association
Research on Chiropractic for Veterans
I am writing to provide additional information relating to your article, "Giving Our Veterans the Care They Deserve," published in the Jan. 29 issue of DC. In the article, you cite an intramural VHA-funded project as the first and only project in response to the call for proposals on chiropractic research. In Minnesota, we are currently conducting a clinical research project funded by the Department of Veteran Affairs. An aspect of this project was just presented at the ACC-RAC conference; specifically the presentation "Chiropractic Institutional Collaboration With Veterans Administration to Implement a Randomized Clinical Trial: A Pilot Study."
More information about this ongoing trial can be found at http://clinicaltrials.gov/ct2/show/NCT00561652. I'm glad to see stories of ongoing research efforts not only for the potential implication to the chiropractic profession, but also for the benefit of veterans with low back pain.
Craig Schulz, DC, MS
Assistant Professor, Research
Wolfe-Harris Center for Clinical Studies
Northwestern Health Sciences University
Primary Care Opportunities
Your latest editorial ["A Golden Opportunity in Primary Care," Jan. 15 DC] discusses an opportunity dear to my heart. My training at National University of Health Sciences gave me the basic skills to be a chiropractic physician, and my further education as an chiropractic internist has been invaluable in my desire to practice primary care. Do you understand the difficulties in such a practice as a DC? Identifying those difficulties would be very helpful in creating a strategy to guide our profession in its political and educational efforts in taking on such clinical responsibilities. The education is easier to obtain than getting paid, that's for sure.
Steven G. Lumsden, DC, PC
"An Academic Slap in the Face!"
In a recent article, Dr. Thomas Hyde indicates that one important educational issue is eliminating specialty certifications and replacing them with master's level programs ["Person of the Year: Thomas Hyde, DC," Jan. 16, 2008 issue]. I have seen this idea several times, including at a chiropractic college that is implementing this type of "advanced" certification with a master's program. There is a problem here. The chiropractic degree is a terminal doctoral-level degree. There is no degree beyond a terminal doctoral degree.
An advanced certification is fine for specialties, but not a master's degree. A master's degree is academically below the level of the doctor degree and advanced training beyond the DC cannot academically be a master's level course. Postdoctorate is fine or advanced board certification like the medical doctors, osteopaths, dentists and others have, but a master's degree as an advanced degree for a DC is an academic slap in the face to us!
Can you imagine the medical board requiring a master's degree for an MD for specialization? They are not ignorant enough to publicly embarrass themselves in front of the entire academic community. Let's try just once to get in step with the rest of the world.
Tim McCullough, BS, MEd, DC, DABCI
Past President, ACA Council on Diagnosis and Internal Disorders
Letters to the Editor should be submitted to . Please include your name, academic degree(s)/credentials, and the city/state in which you practice. Submission is acknowledgement that your letter may appear in a future issue of the publication, but does not guarantee placement. We receive considerable correspondence and try to publish as many perspectives as possible.