Lori Boukas, marketing director, ZT Technical Services Inc, Northbrook Ill

Offering neurodiagnostic testing in the comfort of your own office can be benefical, not only finanically, but also to your patients. Chiropractic Products asks Lori Boukas, marketing director of ZT Technical Services Inc, Northbrook, Ill, for the technical and legal aspects of offering this diagnostic testing.

What is the scope of a chiropractic neurologist and neurodiagnostic testing?
Drawing a parallel to the medical neurologist and excluding pharmacological or surgical treatment, the chiropractic neurologist performs essentially the same functions. Neurologists are specialists in assessing the nervous system, both CNS and PNS through clinical neurological examination and diagnostic modalities, such as CT, MRI, MRA, ultrasound, and neurodiagnostic testing (ie, nerve conduction velocity studies (NCV, needle electromyograms (EMG), somatosensory evoked potentials (SSEP)). Following the assessment of a referred patient, a report with impressions is sent back to the referring doctor.

Depending on the regulations of each state, chiropractic neurologists have a liberal or limited use of modalities, such as NCV and needle EMG. Neurodiagnostic testing is comprised of a series of electrical tests that examine the integrity and specific characteristics of mainly the peripheral nerve tissues. NCV and SSEP studies are noninvasive tests, which often provide the objective documentation needed to help DCs determine the cause and location of the lesion, decide the most effective course of treatment, provide differential diagnosis, and help substantiate the need for necessary follow-up care to third parties.

What are the financial benefits in offering diagnostic testing?
First and foremost is the benefit of not having to make the capital investment in purchasing equipment. Problems associated with equipment obsolescence and maintenance do not fall under the purview of the doctor or practice. Secondly, there are no training costs to the doctor; the testing company has highly trained resources to administer the tests. Finally, there is the ability to collect the revenue from processing claims for the technical portion of the procedure.

What are a few pitfalls in terms of practicing and legal issues?
Quite frankly, I believe that misunderstanding and skepticism have been the largest determent we face. Some doctors do not understand the legality of testing this way. Consequently, some tend to be wary because of cases involving other diagnostic companies where the financial arrangements were not clear or, in some cases, illegal.

Advancements in technology have allowed for the capability of bringing state-of-the-art diagnostic testing equipment to the office. Since the equipment and technicians are leased, and the DC is supervising the procedures, it is a legal arrangement, and the DC is able to bill for the technical component of the testing procedures.

Describe a few billing and coding aspects of diagnostics and dealing with processing claims.
Diagnostic testing falls under the category covered by the CPT modifiers—a system developed for billing purposes—and can be broken down into professional and technical components, thus allowing the practice to bill for part of the service and collect the appropriate reimbursement. Also, this does not have an effect on the chiropractic cap.

What do you see for the future of chiropractic?
The public will continue to embrace chiropractic because of its effectiveness. The public, while sometimes naïve, is in the end the ultimate litmus test. Chiropractic, as it becomes more and more mainstream and integrated into the health care system, will only progress because it is true that “it works!” Specialties within chiropractic are necessary and a sign that the profession is not only growing, but that it is addressing the ever burgeoning needs of the population it serves.