| Scope of Practice Change |  | |
How HB 2501 Chiropractic Practice Act Changes May Impact L&I Claims from Chiropractors
In June 2002, a change in the chiropractic scope of practice law went into effect that did three things:
- Removed language requiring extremity manipulation to be performed only in conjunction with spinal adjusting.
- Removed the prohibition for billing for extremity manipulation
- Reduced restrictions on nutritional counseling.
These latter two changes will not have any effect on L&I claims as nutritional counseling is not a workers compensation benefit in Washington, and extremity adjusting is already included as a component of the L&I chiropractic care fee schedule. However, the change in the law means that chiropractors can now treat injured workers with extremity problems even if there is not a need to perform a spinal adjustment.
In the past, a spinal condition needed to be part of the accepted occupational disease or injury in order for the DC to be an attending doctor. In cases without this, a broader scope practitioner was usually required to be the attending doctor. In some cases, chiropractors could be concurrent care providers if requested by the broader scope practitioner. Because this linkage is no longer required, chiropractors may be allowed to be attending doctors in claims for occupational extremity conditions.
Although the changes permit chiropractors to bill for extremity manipulation as a separate service, L&I claims will not be affected 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.
Some L&I extremity condition claims may still be required to be managed by a different provider when medications are prescribed or surgery is probable. Like any change of a long-standing practice, it may take time for both doctors and L&I staff to get used to changes. If you are not allowed to be an attending doctor on a case you think you should be, clarify with the claim manager if there are issues other than scope of practice involved. If not, you may want to communicate with the unit supervisor or suggest that the claim manager ask an internal occupational nurse or chiropractic consultant to review the claim.
Several occupational extremity conditions may require special knowledge and skill. For example, carpal tunnel syndrome is usually considered an occupational disease, rather than an injury. The attending doctor may need to perform a comprehensive exposure history in order document responsibilities of previous employers. In addition, occupational disease claims can take much longer to adjudicate and may require a great deal of additional administrative work than injury claims.
As another example, some shoulder injuries cause significant connective tissue damage. Because of the complexity and the extensive amount of soft tissue in shoulder joints, delays in rehabilitation may readily lead to permanent loss of function. Thus, consequences related to future disability and vocational benefits exist.
L&I and the WSCA are developing future provider education programs that will help improve provider skills in such areas.
