scale that's the one that has the sad or happy face, the McGill Pain Questionnaire is multidimensional. Those are all very nice, but very long. I think it's better to have something simple and that's why I would recommend having the last one here, it says the visual analog scale, just the simple what is your pain today? On each visit I tell you just simply do a verbal, what is your pain level today on pain scale of 1 to 10. Here's what we do, patient comes in on the first visit, we do a pain assessment. On the 1500 form along with the 98940, you will put the code G8730. You notice here that line of billing has 98940 AT and just below it has G8730. Then you notice across, the price of it is one penny. Medicare does require that we make it a penny. It has to have a little bit of value, but it's not something we collect. All we're indicating with G8730 is the patient reported there's positives pain, so anything from 1 to a 10 would make this true and you simply have to make sure that there's a follow-up plan, we're going to treat the patient accordingly. You can see it's not that difficult, simply put on the extra line G8730 with indicating that there was pain. Note again, no value and again every single visit however, so that means you're going to have one code just for that. Let's do, what about a patient that comes in and you're done treating, they feel good. Their pain assessment is documented as negative. You will put on the claim for G8731 on that visit and what does that indicate to Medicare? Their pain today was negative, in other words patient say, “Doc, I'm feeling good, there's no more, pain I'm going to release you.” That's pretty simple, I think those are the two we're going to use most commonly G8730 when the pain is positive, G8731 when the pain is negative. However, there could be other issues that may come up with a patients. Let's go into some of those. Sam, before we go on, can we go back to the last one, the G8731, a lot of the doctors on our end of the profession are used to taking care of patients, whether they be Medicare or not that aren’t in pain because if they're looking to detect and correct vertebral subluxation, sometimes there's pain present, but sometimes there's no pain whatsoever. If there's no pain, does that mean that they have to be dismissed off of Medicare or they can't be billed or you won't be paid because we're being paid for the correction of a subluxation. The pain is not always an indicator if they're subluxated or need an adjustment either which way. How does that come together? Well that's good that you bring that up because Medicare does require if there's no pain, they're going to consider the care as maintenance. Now that doesn't mean you can't treat the patient, but if they have zero pain and no dysfunction, Medicare is not going to consider that a corrective care. Now from a chiropractic standpoint, I agree that we are correcting subluxation, but what Medicare says in order to be paid is that there must be subluxation with a secondary neuromusculoskeletal conditions that will give some level of pain. If you have a patient with zero pain that's fine, but that will be a maintenance patient and then of course they would have to sign what's called an Advanced Beneficiary Notice, commonly termed ABN. Then that way, you would inform Medicare that it's a maintenance visit once they've signed that form by billing your adjustment code or CMT code with modifier G8 to indicate that it's maintenance or not paid by Medicare, so the patient is liable. Only when there is pain or there is a going to be a correction in the sense of reduction of pain or increase in function can we bill with an AT.
Dr. Stu:
Dr. Sam:
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