Scope of Practice Change Q&As
 

Questions and answers about the impacts of HB 2501 on L&I practices

What effect does HB 2501 have on L&I claims?

The change in the chiropractic scope of practice law means that chiropractors can now treat injured workers with extremity problems even if there is not a need to do spinal manipulations.

What specifically did HB 2501 change in chiropractic scope of practice?

HB2501 deleted three phrases in the Chiropractic Practice Act:

RCW 18.25.005 Chiropractic Defined (2)

  1. ".extremity manipulation insofar as any such procedure is complementary or preparatory to a chiropractic spinal adjustment." was changed to ".extremity manipulation.", and
  2. ".recommendation of nutritional supplementation except for medicines of herbal, animal, or botanical origin.." Was changed to ".nutritional supplementation." The department is also unaffected by the change in nutritional supplementation as it is not a covered workers compensation benefit.

RCW 18.25.006 Definitions (10)

  1. "Extremity Manipulation". The sentence "The use of extremity manipulation shall be complementary and preparatory to a chiropractic spinal adjustment to support or correct a vertebral subluxation complex and is considered a part of a spinal adjustment and shall not be billed separately from or in addition to a spinal adjustment." was deleted in its entirety. This change makes Washington State's chiropractic practice scope consistent with 48 other states on this issue.

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What date is HB 2501 effective?

June 13, 2002.

How do the changes affect how the department works with claims involving chiropractic care?

This change principally impacts department practice that limited when a chiropractor may be an attending doctor on an accepted extremity condition. Prior to HB2501 chiropractors may not have been allowed to be attending doctors on claims for industrial injuries and occupational conditions originating in the extremities. In order for manipulation of extremity conditions to be within chiropractic scope, 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 have 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 be attending doctors in claims for occupational extremity conditions.

Will the department reimburse separately for chiropractic extremity manipulation using the Physicians' Current Procedural Terminology (CPT™) code for "Chiropractic Manipulative Treatment, extraspinal, one or more regions" (98943)?

No, although HB2501 allows chiropractors to bill for extremity manipulation as a separate service, the department 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.

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Will chiropractors be able to rate impairments in the extremities?

Chiropractors on the department's Approved Examiner List may perform impairment ratings on extremities after the new law goes into effect. 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).

How prepared will chiropractors in Washington State be in terms of their training and experience to manage occupational conditions in extremities?

All accredited chiropractic training programs require training in diagnosis and management of conditions related to the extremities, so most chiropractic doctors in Washington State should have little difficulty with the change. There are also chiropractic post-graduate training programs in injury care, rehabilitation, and sports chiropractic that provide additional training and specialization in extremity injuries and diseases. However, because of Washington State's historically narrow chiropractic practice scope, some doctors may choose to continue to limit their care to spinal conditions only.

Some extremity conditions such as carpal tunnel syndrome are classified as an occupational disease rather than an occupational injury. Some chiropractors in the State may be unfamiliar with many of the adjudicative issues with occupational diseases and may be unfamiliar with the need to take detailed exposure histories and the like. If claim-specific problems arise, the occupational nurse consultants and chiropractic consultants in the Office of the Medical Director (Drs. White and Austin) are available to assist claims staff.

Will the department provide additional training for chiropractors?

The department is working with the Washington State Chiropractic Association, the Chiropractic Advisory Committee, and is enhancing its provider education programs to disseminate information to chiropractors in the state regarding differences in the management of occupational extremity conditions. Additional training is planned for the basic workers compensation courses, the chiropractic consultant programs, and the chiropractic IME courses to enhance occupational exposure history skills and extremity management issues beginning with the Summer and Fall 2002 programs.

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