Jennifer
Your lack of biomechanical knowledge is showing. The knee bone is connected to the ??? bone, only kidding. I agree with the other Doc. Also is he wanted to do fraud he would use the 98942 code I think. Lastly, several years ago the Adjustment (97250)/OV combination was fairly accepted practice before the 9894* series was developed. Maybe he just hasnt kept up.

The spine functions biomechanically as a helix not according to some two dimensional regional concept administered by Medicare.

This Doctor is a full spine adjustor as are many if not most chiropractors.

This means that the Doctor makes medical decisions based on the biomechanics of that patient's whole spine, short leg adaptations, gait, scoliosis, segmental abnormalities, compensation patterns, muscular fiber tautness or laxness.

This means that according to the treatment protocol, if the Doctor doesnt adjust the cervical/thoracic compensatory changes when the patient has low back pain either the patient may develop neck/upper back pain or the low pain pain may reoccur or not resolve.

3-4 regions are adjusted in my practice 80% of the time. 5 regions 5% and one region 15%. When these codes were developed I read somewhere that HCFA thought that the 40 code would be used about 20%, 41 code about 70%, and the 42 code about 10%.

Medicare allows us to put the additional Dx's in line 19 in IL. For regular insurance, I put down the primary complaint in slot one followed by the 739 code for the primary region, number 3 is the FUNCTIONAL problem (spondylosis, stenosis, facet arthrosis, myofascitis, muscle spasms) and number four is 739 code for the next region that is most involved. This is the way I was taught and it may not be perfect.

Remember also that if the Doctor adjusts the lumbo-sacral region, the sacro-iliac region and a thoraco-lumbar jxn...that's 3-4. That is the one of the most common treatments due to the anatomy of the iliopsoas and he would only need one presenting complaint.

The ACA also puts out a nice manual just for these types of questions. Maybe this Doc should invest 50 bucks.