CROFT IV-MODERATE TO SEVERE
Page 1 of 1
CROFT IV-MODERATE TO SEVERE
by Admin Thu Oct 01, 2015 12:55 pm
The Schmidt Law Firm strongly recommends that all SOAP notes contain a statement of medical necessity which should have a major positive effect on getting your treatment bills paid. We recommend of the following text referencing the Croft Guidelines for injuries that would be categorized as a Croft Category IV injury (Moderate to Severe)
The treatment that has been rendered to Mr. XXX is consistent with, and conservative, in relation to the recognized parameters of treatment. Standards for the frequency and duration of chiropractic treatment have been established as the “Best Practices & Practice Guidelines” (commonly referenced as the Croft guidelines) established and published by the US Department of Health and Human Services Agency for Healthcare Research and Quality. In accordance with these standards, Mr. XXX’s injury is classified as a Grade IV (Moderate to Severe) which is meet the requirements of one of the following conditions: “limitation of range of motion, ligamentous instability, neurological findings present, fracture or disc derangement.” Mr. XXX’s condition qualifies for rating within that category on the basis of three of those criteria, namely (1) limitation of range of motion, (2) ligamentous instability, and (2) disc derangement. Treatment parameters within the Grade IV category call for daily treatment for up to 3 weeks, treatment 3 times a week for up to an additional 16 weeks, treatment 2 times a week for up to an additional 12 weeks, 1 time per week for an additional 20 weeks, and PRN treatment thereafter. The treatment that has been rendered to Mr. XXX is considerably less than the maximum allowed in this category and most clearly consistent with this nationally recognized standard.
The treatment rendered has also been within the parameters of treatment established by the Minnesota Chiropractic Association Standards of Care in the following respects:
1. A Traumatic Severe Sprain/Strain Injury to the Cervical, Lumbar and Thoracic spine as defined in the Minnesota Chiropractic Standards of Care, section 4(d) with subluxations, secondary cervicalgia (headaches), and chronic myositis/myalgia.
2. A myofascial injury as defined by the MCA Standards, section 2 with significant pain, limitation of motion and muscle spasm, followed by the development of trigger points and chronic myofascial pain syndrome which has been documented by repetitive pain assessments. This condition has been determined to be severe.
3. Injury to the facet joints of the Cervical, Lumbar and Thoracic spine producing chronic facet-mediated pain as defined in the MCA Standards, section 2, as a Chronic Neuromusculoskeletal Condition.
4. Injury to the intervertebral discs of the cervical spine, i.e. broad-based disc bulge/protrusion at the C5-6 and C6-7, as documented by MRI and as defined by MCA Standards, section 4(f).
5. Injury to the intervertebral discs of the lumbar spine, i.e. central subligamentous protrusion with annular tear at the L5-S1, as documented by MRI and as defined by MCA Standards, section 4(f).
6. Injury to the ligaments of the cervical spine, as documented by Digital Motion Xray and CRMA performed in accordance with the Council on Chiropractic Practice’s Clinical Practice Guidelines, 4th Ed (2013), section 3.8.
The treatment that has been rendered to Mr. XXX is consistent with, and conservative, in relation to the recognized parameters of treatment. Standards for the frequency and duration of chiropractic treatment have been established as the “Best Practices & Practice Guidelines” (commonly referenced as the Croft guidelines) established and published by the US Department of Health and Human Services Agency for Healthcare Research and Quality. In accordance with these standards, Mr. XXX’s injury is classified as a Grade IV (Moderate to Severe) which is meet the requirements of one of the following conditions: “limitation of range of motion, ligamentous instability, neurological findings present, fracture or disc derangement.” Mr. XXX’s condition qualifies for rating within that category on the basis of three of those criteria, namely (1) limitation of range of motion, (2) ligamentous instability, and (2) disc derangement. Treatment parameters within the Grade IV category call for daily treatment for up to 3 weeks, treatment 3 times a week for up to an additional 16 weeks, treatment 2 times a week for up to an additional 12 weeks, 1 time per week for an additional 20 weeks, and PRN treatment thereafter. The treatment that has been rendered to Mr. XXX is considerably less than the maximum allowed in this category and most clearly consistent with this nationally recognized standard.
The treatment rendered has also been within the parameters of treatment established by the Minnesota Chiropractic Association Standards of Care in the following respects:
1. A Traumatic Severe Sprain/Strain Injury to the Cervical, Lumbar and Thoracic spine as defined in the Minnesota Chiropractic Standards of Care, section 4(d) with subluxations, secondary cervicalgia (headaches), and chronic myositis/myalgia.
2. A myofascial injury as defined by the MCA Standards, section 2 with significant pain, limitation of motion and muscle spasm, followed by the development of trigger points and chronic myofascial pain syndrome which has been documented by repetitive pain assessments. This condition has been determined to be severe.
3. Injury to the facet joints of the Cervical, Lumbar and Thoracic spine producing chronic facet-mediated pain as defined in the MCA Standards, section 2, as a Chronic Neuromusculoskeletal Condition.
4. Injury to the intervertebral discs of the cervical spine, i.e. broad-based disc bulge/protrusion at the C5-6 and C6-7, as documented by MRI and as defined by MCA Standards, section 4(f).
5. Injury to the intervertebral discs of the lumbar spine, i.e. central subligamentous protrusion with annular tear at the L5-S1, as documented by MRI and as defined by MCA Standards, section 4(f).
6. Injury to the ligaments of the cervical spine, as documented by Digital Motion Xray and CRMA performed in accordance with the Council on Chiropractic Practice’s Clinical Practice Guidelines, 4th Ed (2013), section 3.8.
Admin- Admin
- Posts : 14
Join date : 2015-09-24 -
Page 1 of 1
Permissions in this forum:
You cannot reply to topics in this forum|
|
|