If the care was provided to reduce vertebral subluxations then this is the outcome measure to be assessed. Further, care is considered reasonable and necessary if any of the following criteria are met:
It was reasonably expected to improve the patient’s condition at the time it was rendered;
It has improved the patient’s condition;
It prevented the onset of any permanent disability;
It assisted the patient to achieve maximum functional capacity in performing the patient’s daily activities;
It alleviated the patient’s pain and/or mitigated the severity of the patient’s symptoms;
It ameliorated the patient’s condition;
It provided relief of the patient’s pain;
It prevented the worsening of the patient’s condition;
It slowed the natural progression of the patient’s condition or disease;
It was appropriate for the patient’s symptoms, re- injuries, exacerbations and diagnoses of the patient’s conditions or injuries;
It was provided consistent with the attending treating doctor’s diagnosis; and/or
It was provided consistent with the patient’s active symptomatology and/or abnormal physical/chiropractic findings.
Chiropractic reviews should specifically reference the above criteria when making chiropractic necessity determinations, and state why any of these criteria were satisfied or why they were not. In order to be reliable and credible, the chiropractic peer review should be specifically referenced and the evidence and basis of the rationale for the review should be easily identifiable. While the peer review is the opinion of the reviewer it cannot be random and without proper justification. Should the reviewer reference any literature or guideline source, the reviewer should document and explain specifically how that reference applies to the treatment in question, and the reference should be directly quoted from the source used, and include the exact wording and page number.
In order to be reliable and credible, the chiropractic peer review should be specifically referenced and the evidence and basis of the rationale for the review should be easily identifiable. While the peer review is the opinion of the reviewer it should not be random
_________________________________________________________ 88 Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision