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 should be requested by the attending doctor who notifies the claim manager of this action.

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?

Service requested	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:

• 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:
• Chiropractic treatment technique: A Maximum of 20 hours may be included,
• Diagnostic assessment,
• Diagnostic imaging,
• Exam and evaluation methods,
• Neurology,
• Occupational health practices,
• Orthopedics.

• Have an active L&I provider number.
• 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.
• 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.
• Complete two required L&I seminars less than two years before submitting your application:
  • "Reducing your Practice Headaches: Industrial Medicine Tips for Treating Doctors" and
  • "Chiropractic Consultant Seminar"
• Maintain a current license to practice in Washington state.
• As an attending doctor, routinely perform the following during patient management:

• Document treatment in the SOAPER or similar format.
• Submit narrative reports every 60 days.
• Conduct closing exams and submit reports to the insurer.
• Comply with L&I requests.
• Submit an Activity Prescription Form when appropriate or requested.  See http://www.lni.wa.gov/ClaimsIns/Providers/Manage/RTW/ActivityRx/default.asp
• Obtain consultations as clinically indicated and prior to 120 days of conservative care.

Application process

L&I has open enrollment for chiropractic consultants.  Submit this form and your documentation to: 
L&I, Provider Review and Education
PO Box 44322
Olympia WA 98504-4322

Schedule of L&I pre-requisite seminars

• "Reducing your Practice Headaches: Industrial Medicine Tips for Treating Doctors", December 12, 2009 in Tukwila, WA. See http://www.lni.wa.gov/ClaimsIns/Providers/Research/Courses/default.asp
• "Chiropractic Consultant Seminar" October 2010, in Tukwila, WA. Date TBD

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:
• Chiropractic treatment technique: A Maximum of 20 hours may be included,
• Diagnostic assessment,
• Diagnostic imaging,
• Exam and evaluation methods,
• Neurology,
• Occupational health practices,
• Orthopedics.
• 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:
  • Document treatment in the SOAPER or similar format.
  • Submit narrative reports every 60 days.
  • Conduct closing exams and submit reports to the insurer.
  • Comply with L&I requests.
  • Submit an Activity Prescription Form (APF) when appropriate or requested.  See the APF website for more details: http://www.lni.wa.gov/ClaimsIns/Providers/Manage/RTW/ActivityRx/default.asp
  • Obtain consultations as clinically indicated and prior to 120 days of conservative care.

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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