Pounding, pulsating, unforgiving headaches are a constant source of pain and confusion for victims of moderate to severe trauma.

Oddly, few DC’s emphasize the seriousness and debilitation of headaches.

But look at the ICD-9 for a board menu of headache disabilities. Proper diagnosis of a long, ruinous headache trauma is recognized by Colossus, juries and judges.

339.12	chronic intractable
339.00	cluster syndrome
339.43	primary thunderclap
339.85	primary stabbing
339.20	post traumatic
339.21	acute post traumatic
339.22	chronic post traumatic
346.00	migraine

Each is a powerful diagnosis and justifies significant care---perhaps even a neurological referral. We should see these diagnosis much more frequently.

Gary Lewkovich, DC claims that proving care necessity is a key road block keeping DC’s from getting paid in PI. We agree.

For example, this week we saw a bill for ‘hydrotherapy’ at $150 for each session for over 30 visits. As best as we can tell, the doctor did not perform any adjustments. The ‘hydrotherapy’ could be a moving water bed.

The adjuster gleefully responded that the 25-year-old patient could have received a 2 hour massage along with a pedicure each time.

Certainly such billing will not work, nor get you paid.

Consider these 5 factors for care justification:

1.	The patient must have a chiropractic problem. DX needs to be squarely in the muscular skeletal arena
2.	Care given must be ‘recognized’ as useful. Avoid experimental and water therapy.
3.	Care must be used in accepted manner: Modalities are expected in acute phase, not in conservative management
4.	Care must be Cost Effective: Consider how much the average juror pays for a DC visit.
5.	Show substantial results: Most patients don’t heal 100%, but there ought to be improvement from acute pain.

See the entire form by asking johntawlian@shawnsteel.com for your copy. It is a great read.