Chiropractic Consultation Program

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This is a second opinion program in Washington state. Doctors can ask for assistance with diagnosis or treatment planning.

Listing of approved chiropractic consultants

View the current list of approved chiropractic consultants.

Second opinions, what do I need to know?

Prior authorization is not required, but must be requested by the attending doctor.

A second opinion...
is required when:	is optional when:	may not be referred by the attending doctor if:
120 days of conservative care have passed or A complication, controversy or dispute arises over the treatment of injured worker or The insurer requests a consultation exam.	The worker's accepted condition presents a diagnostic or therapeutic problem.	An independent medical exam (IME) has already been requested by the claim manager or Claim reopening is pending or Claim is closed.

What is the difference between IMEs and chiropractic consultations?

	Referral source	Type of exam	Select examiner from	Prior authorization required?
Chiropractic consultation	Attending doctor. Note:May not refer if an IME has been requested.	Second opinion.	Chiropractic consultant list or refer to a medical specialist.	No.
Independent medical exam	L&I claim manager.	IME exam.	Approved IME provider.	Yes. By L&I claim manager.

How do I bill for chiropractic consulting?

Billing codes

Approved chiropractic consultants may bill the first four levels of CPT® office consultation codes: 99241, 99242, 99243, and 99244.

Forms

To bill L&I for services, use the CMS 1500 form.

How do I become a chiropractic consultant?

You must meet the minimum requirements, before submitting a chiropractic consultant application:

1. Proof that you have completed:
• 30 hours of CE during the year before submitting an application, and
• At least 180 hours of post-graduate continuing education (CE) in these subject areas:
• Neurology,
• Spinal orthopedics,
• Pectoral and pelvic girdle orthopedics,
• Osseous roentgenology,
• Exam methods,
• Methods of adjusting or manipulation and
• Human biomechanics.
2. Have an active L&I provider number.
3. Been in an active clinical practice for 5 years with at least 2 years in Washington state. At least 50% of your practice in Washington is devoted to patient management including treatment of injured workers. Full or part time practice requires an average of 8+ hours per week in the past 2 years.
4. Show a pattern of practice consistent with L&I's utilization standards and Medical Aid Rules and Fee Schedules. Be in good standing with L&I.
5. Complete a basic level Washington State Workers' Compensation course, such as "Reducing your practice headaches".
6. Complete L&I's seminar on chiropractic consultations.
7. Maintain a current license to practice in Washington state.
8. As an attending doctor, routinely perform the following during patient management:
• Keep records in a SOAPER or similar format.
• Submit progress notes every 60 days or more often, as needed.
• Conduct closing exams and submit reports to the insurer.
• Comply with L&I requests.
• Certify time loss and return-to-work ability, when appropriate.
• Comply with 120 day consultation requirement.

Application process

Every 2 years (even numbered years) L&I has an open enrollment period for chiropractic consultants. The next open enrollment period is fall of 2008:

• August 2008, applications are mailed to chiropractors in Washington. If you do not receive an application my mid-September 2008, e-mail: mdan235@LNI.wa.gov.
• November 28, 2008, L&I must receive your application and all supporting documentation.
• May 2009, successful candidates will be contacted.

Schedule of L&I seminars

Required to become a consultant:

Registration materials will be mailed to all chiropractors in Washington six weeks before each event.

October 11, 2008
"Chiropractic Consultation Seminar". To obtain the registration flier after September 1, 2008, go to L&I's Courses & Seminars site.

November 15, 2008
"Reducing Your Practice Headaches: Industrial Medicine Tips for Treating Doctors". To register, after October 1, 2008, go to L&I's Courses & Seminars site.

Optional:

September 13, 2008
"Advanced Topics in Workers' Compensation: Physical Capacities Calculation and Return-to-Work". Registration materials will be mailed to doctors in Washington. To obtain this registration flier after August 8, 2008, go to L&I's Courses & Seminars site.

Requirements for ongoing chiropractic consultants

• Be in an active clinical practice in Washington State.
• Have at least 50% of your practice devoted to patient management including treatment of injured workers. Full or part time practice requires an average of 8+ hours per week in the past 2 years.
• Complete 30 hours of continuing education every year in subjects such as:
• Neurology,
• Spinal orthopedics,
• Pectoral and pelvic girdle orthopedics,
• Osseous roentgenology,
• Exam methods,
• Methods of adjusting or manipulation and
• Human biomechanics.
• Every 2 years attend L&I's:
• Chiropractic consultant seminar or
• Chiropractic independment medical examiner seminar or
• Any other pertinent programs sponsored by L&I.
• Show a pattern of practice consistent with L&I's utilization standards and Medical Aid Rules and Fee Schedules. Be in good standing with L&I.
• As an attending doctor, routinely perform the following during patient managemenet:
• Keep records in a SOAPER or similar format.
• Submit progress notes every 60 days or more often, as needed.
• Conduct closing exams and submit reports to the insurer.
• Comply with L&I requests.
• Certify time loss and return-to-work ability, when appropriate.
• Comply with 120 day consultation requirement.

Applicable Laws (RCW) and Rules (WAC)

WAC 296-20-01002 - Definitions: Consultation examination report.
WAC 296-20-035 - Treatment in cases that remain open beyond 60 days.
WAC 296-20-045 - Consultation requirements.
WAC 296-20-051 - Consultation.
WAC 296-23-195 - Chiropractic Consultations.

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