Chiropractic care for occupational extremity conditions

Effects of 2002 Legislation

In 2002, the legislature made a change to the chiropractic scope of practice which removed a requirement that extremity manipulation could only be performed if a concurrent spinal condition existed. This change allowed chiropractors to treat injured workers even if there is not a need to do spinal manipulations.

How did this affect how the department and self-insurers work with extremity-condition claims involving chiropractic care?

This change principally impacted a department practice when a chiropractor may be an attending doctor on a claim with an accepted extremity condition. Prior to 2002, a spinal condition needed to be part of the accepted occupational disease or injury. In cases where a spinal condition has been an accepted condition as well, chiropractors had already been treating injured workers' extremities. In the past, cases without a spinal condition as part of the accepted condition, a broader scope practitioner may have been required to be the attending doctor. Because this linkage is no longer required, chiropractors can now independently be attending providers in claims for occupational extremity conditions.

Is extremity manipulation reimbursed separately under Washington workers compensation using the Physicians' Current Procedural Terminology (CPT™) code for "Chiropractic Manipulative Treatment, extraspinal, one or more regions" (98943)?

No. Athough the 2002 change allows chiropractors to bill for extremity manipulation as a separate service, L&I was not affected by this change because extremities are already included as a body region in the department's chiropractic care codes (2050A, 2051A, 2052A). This is similar to how osteopathic extremity manipulation is reimbursed. Additional information on chiropractic payment policy may be found in L&I’s Fee Schedules.

Can chiropractors rate impairments in the extremities?

Yes, chiropractors on the department's Approved Examiner List may perform impairment ratings on extremities. Most chiropractors in Washington State who perform impairment ratings already are familiar with the AMA guides and many already perform extremity impairment ratings for other insurers (eg, in car accident cases). Extremity rating has been a part of mandatory training for chiropractors on the approved examiner list since 2002.


Additional resources for chiropractic care of occupational extremity conditions

Evaluation and care of extremity conditions has been included in the training for doctors of chiropractic at all accredited chiropractic colleges in the US and Canada for many decades.  L&I has included additional training for extremities in its consultant and IME courses.

The Industrial Insurance Chiropractic Advisory Committee has developed several evidence-based conservative care practice resources for several occupational health conditions including extremity problems. Additional resources will be posted as they are completed and approved by the committee.

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