patient can't do it, let's look at the third bullet here. The patient cannot report due to mental or physical [inaudible 00:41:09], what if they're in such severe pain, they don't have time to sit in the waiting room for 10 minutes, filling out this form because their back pain is killing them. We want to treat them, so I get that. We put G8540 in that instance. Noticing again, it's just giving us a way of reporting something on the visit whether or not we did it or didn’t do it. Then, there’s another code G9227, the provider performed a functional assessment using the standardized tool and found deficiencies, but didn't follow up with a care plan. Again, this is just, “Oops again, I kind of forgot, if you will,” so there's pain, but I didn’t make a treatment plan.” This I find hard to happen because I'm pretty sure most chiropractors make a treatment plan right from the beginning. You don't redo the treatment plant each time, but let's say it's time for treatment plan and you forget, you would report this. Then I would suggest on the next visit, report the one that you did do obviously a treatment plan. Again, this is mostly just to give you a proper scenario of when it happens or what happens. What about if you come in and you go, “I just forgot.” Let's say it's 30 days and maybe you have a protocol in your office, where every 30 days your staff is to give the patient the form to fill out, but for some reason it was forgotten. Well, no big deal, just report G8541 that it was forgotten and then the next visit, simply do it again and then of course report that G8539. Again, lots of scenarios for these issues. Then of course, if you just say, “You know what, we did an assessment with the tool, found functional deficiencies, but again no follow up care because the patient was ineligible, maybe they were in severe pain,” again another scenario for that. These extra codes start to be a bit daunting and I think you go, “Oh my God, this seems confusing.” I say, “Let's keep it simple.” Visit one, when the patient comes in, you do the pain scale. You're going to report G8730 and you did a functional scale G8539, means pain is positive, there's a functional deficit, let’s treat. When they come back in the second visit, we're going to report G8730 again because that visit we're reporting pain, but notice now we have G8942, there's a functional scale on file within the past 30 days. Notice the second visit isn't the 8539, G8942, so notice again just the two codes.
Dr. Stu:
Sam, I want to ask you a question about that.
Dr. Sam:
Sure.
Dr. Stu:
The doctors that are using an EMR system that can be helpful with that every 30 day rule so to speak. do you have any recommendations to make this a little less daunting for the doctors to know where they are at with this every 30 days when they're using paper records? What I would do is to, I would make sure that the doctors that are doing paper records to simply have a format and protocol that allows them to know when is the 30 days up. If a patient comes in on today's visit, I would look on the calendar when is 30 days and I will put a sticky note, I mean something that simple on the file that says, “The 30th day
Dr. Sam:
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