A Civil Court in a published decision rebuked an ill-fated, ill-conceived and senseless challenge to the proposition that a chiropractor may perform and bill for MUA services.
John Giugliano, DC, P.C. v Merchants Mut. Ins. Co., 2010 NY Slip Op 20308 (Civ. Ct. Kings Co. 2010)
While I might have my own personal misgivings about the MUA procedure and how it is being performed in the no-fault world, a chiropractor may bill for it. I can discuss here how some of the MUA procedures I see being done should be reported to the Department of Education or OPM. Yet, that is not the purpose of this discussion.
The reason why the defense practitioner in this case was way off the mark in defending this matter, is based upon an opinion letter, dated 8/14/09 from the general counsel of the Workers’ Compensation Board, Kenneth J. Munnelly, which says this:
“For example, if an appropriately trained chiropractor performs MUA, then that chiropractor can bill under the pertinent codes. The CPT Codes most commonly billed under are 22505 and 27275. The relative value unit (RVU) is established for such CPT codes by the official medical fee schedule and remains constant whether a medical doctor, osteopathic doctor or chiropractor bills for that service using that code. The reimbursement rate, however, differs based upon the conversion factor assigned to the type of provider. The comparison of conversion factors that an osteopathic doctor would bill versus the factor under which a chiropractor would bill indicates that the chiropractor should be billing and get paid at 68.4% of the allowable conversion factor for the medical and osteopathic doctors performing the same procedure.”
You can find this letter in various arbitration decisions, e.g., AAA # 412010007480. I am still looking for a copy of the actual letter.
We can all agree, I think, that an opinion letter from the agency that is in charge of the fee schedule, which says that a chiropractor may bill for MUA services, ends the debate.
But I also have similar misgivings about why Plaintiff did not make a summary judgment motion, or even bothered calling a rebuttal witness at the trial in this matter. The facts of this case did not present any factual issues; it involved an issue of law that was properly decided adversely to the insurance carrier.
I mean if an insurance carrier -justifably- can waive an opinion letter and create Fogel and Great Wall, then why is this any different? The shoe was on the other foot in this case. It happens.
3 Responses
What about chiropratic manipulation while under the influence of marihuana or strong cold vodka?
J.T. where do you see this line of cases going. Will there be reimbursement for psychological treatment of depression and anxiety brought on by the trauma of chiropractic manipulation. What other drugs do you see getting covered. Manipulation while under chrystal meth?
Perhaps this will set precedent for a no fault fee schedule for medical marihuana.
I cannot answer that question with a straight face Ray, except to say that you have too much free time on your hands.
I will say that you give away the fact that you used to work in a District Attorney’s office because only a former criminal attorney versed in Article 221 of the New York Penal Law would spell marijuana as “marihuana”. Here is some trivia. Did you know that marihuana was previously found in Article 220 of the New York Penal Law before the 1977 amendments to New York’s drug laws? Also, did you know that the Rockefeller drug law as originally enacted, prior to the 1979 amendments, classified the sale or possession with intent to sell, of any narcotic drug as a class A-III felony – punishable by a mandatory life sentence, with a minimum of between 1 and 8 years?