An interesting Arbitration decision regarding Manipulation Under Anesthesia (MUA) performed by a chiropractor.  Interesting tidbits:

  • Chiropractors may perform MUAs

     

    Respondent alleged that the disputed service “is not normally performed by this type of provider or there are restrictions on what providers can perform this service... 

    The defense that the performance of MUA by a chiropractor is outside the lawful scope of his or her professional practice license has been considered and uniformly rejected by fellow arbitrators. See Flatbush Chiropractic P.C. and American Commerce Ins. Co., AAA Case No. 412010041729, AAA Assessment No. 17 991 23615 10 (arb. Richard G. Martino, Dec. 13, 2010); Flatbush Chiropractic P.C. and Allstate Prop. & Cas. Ins. Co., AAA Case No. 412010019014, AAA Assessment No. 17 991 13816 10 (arb. Philip R. Wolf, Sept. 30, 2010); Flatbush Chiropractic P.C. and Nationwide Ins. Co., AAA Case No. 412010018997, AAA Assessment No. 17 991 11330 10 (arb. Walter R. Winning, Sept. 24, 2010); Flatbush Chiropractic P.C. and Nationwide Ins. Co., AAA Case No. 412010017309, AAA Assessment No. 17 991 10637 10 (arb. Walter P. Higgins, Sept. 16, 2010); Drew DeMarco M.D. and Geico Ins. Co., AAA Case No. 412010016086, AAA Assessment No. 17 991 09936 10 (arb. Walter P. Higgins, July 23, 2010); Universal Medical Practice P.C. and Nationwide Ins. Co., AAA Case 4 No. 412010017275, AAA Assessment No. 17 991 09445 10 (arb. James J. Skelton, July 23, 2010); Flatbush Chiropractic P.C. and Nationwide Ins. Co., AAA Case No. 412010014919, AAA Assessment No. 17 991 09442 10 (arb. James J. Skelton, July 15, 2010); Michael Demartinis DC and Geico Ins. Co., AAA Case No. 412010001587, AAA Assessment No. 17 991 03129 10 (arb. Regina Anzalone Kurz, May 10, 2010); Blumental Chiropractic P.C. and Auto One/General Assurance, AAA Case No. 412009020285, AAA Assessment No. 17 991 13343 09 (arb. Toby Susan DeSimone, March 1, 2010).

     

  • Chiropractors can work on body parts other than spine

     

    Contrary to Respondent’s assertion, the New York State Workers’ Compensation Fee Schedule does not prohibit chiropractors from performing manipulation under anesthesia. In fact, in responding to an inquiry from an insurer, the Workers’ Compensation Board in an opinion letter from its General Counsel, Kenneth J. Munnelly, Esq., dated August 14, 2009, advised that appropriately trained chiropractors may perform MUA procedures and bill under the pertinent codes. 

    Likewise, according to Douglas E. Lentivech, current Executive Secretary of the New York State Board for Chiropractic of the New York State Education Department, a chiropractor with additional certification may perform manipulation under anesthesia. (Opinion letter dated September 9, 2009). 

    Moreover, New York State law authorizes chiropractors to work on parts of the body other than the spine as long as the purpose of the treatment is “removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment, or subluxation of or in the vertebral column.” (Opinion letter dated April 17, 2001 from Norman G. Cohen, Executive Secretary of the New York State Board for Chiropractic of the New York State Education Department). A second letter also dated April 17, 2001 from Mr. Cohen further provides: “Consequently, to remove nerve interference and its effects, a chiropractor may detect and correct structural imbalance, distortion or subluxation in the human body, including extraspinal parts….”

     

  • Appropriate Fee Schedule for MUAs

     

    In his Opinion letter dated August 14, 2009, Kenneth J. Munnelly, Esq., General Counsel of the New York State Workers’ Compensation Board, advised about the appropriate billing for MUA performed by a chiropractor: 

    A comparison of conversion factors that a medical or osteopathic doctor would bill versus the factor under which the chiropractor would bill indicates that the chiropractor should be billing and get paid at 68.4% of the allowable conversion factor for medical and osteopathic doctors performing (MUA). Additionally of note in billing is that when a medical provider bills from the surgery portion of the fee schedule, reimbursement is subject to all relevant Ground Rules in that subsection of the fee schedule, such as Ground Rule 5 for multiple procedures.

     

     

Chiropractic peer reviewers often bring up the fact that the treatment was on a part of the body other than spine and they conclude (erroneously) that that deems the treatment medically unnecessary.

New York State law authorizes chiropractors to work on parts of the body other than the spine as long as the purpose of the treatment is “removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment, or subluxation of or in the vertebral column.” (Opinion letter dated April 17, 2001 from Norman G. Cohen, Executive Secretary of the New York State Board for Chiropractic of the New York State Education Department). A second letter also dated April 17, 2001 from Mr. Cohen further provides: “Consequently, to remove nerve interference and its effects, a chiropractor may detect and correct structural imbalance, distortion or subluxation in the human body, including extraspinal parts….”

See Bronx Chiropractic Services,PC v. American Transit Insurance Company

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