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Actual Concussion Case Claims adjuster: “but she didn’t hit her head.” Eggleston: “Her head hit the head restraint.” Eggleston: “Her head.

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Presentation on theme: "Actual Concussion Case Claims adjuster: “but she didn’t hit her head.” Eggleston: “Her head hit the head restraint.” Eggleston: “Her head."— Presentation transcript:

1 Actual Concussion Case Claims adjuster: “but she didn’t hit her head.” Eggleston: “Her head hit the head restraint.” Eggleston: “Her head hit the head restraint.” Adjuster: “It doesn’t say that anywhere in the medical records.” Adjuster: “It doesn’t say that anywhere in the medical records.” Eggleston: “it is so obvious that doctors don’t waste their time writing it down.” Eggleston: “it is so obvious that doctors don’t waste their time writing it down.” Adjuster: “but it’s not in the records.” Adjuster: “but it’s not in the records.” Eggleston: “If you fall out of a boat on a lake, would you hit water?” Eggleston: “If you fall out of a boat on a lake, would you hit water?” Adjuster: “Of course.” Adjuster: “Of course.” Eggleston: “It is just as obvious that your head will hit the head restraint in a rear-ender. That’s the name of the device, to restrain the head during a rear-end impact.” Eggleston: “It is just as obvious that your head will hit the head restraint in a rear-ender. That’s the name of the device, to restrain the head during a rear-end impact.” Adjuster: “But it doesn’t say she hit her head so we don’t believe she could have a concussion.” Adjuster: “But it doesn’t say she hit her head so we don’t believe she could have a concussion.”

2 Write it Down “Head hit the head restraint” “Head hit the head restraint” The doctor’s records are “Just The Facts, Maam” of the case. The doctor’s records are “Just The Facts, Maam” of the case. Doctor’s records are essentially ALL the facts used by both sides to negotiate. Doctor’s records are essentially ALL the facts used by both sides to negotiate. If you don’t write it down, it doesn’t exist in the legal negotiations when settling a case. If you don’t write it down, it doesn’t exist in the legal negotiations when settling a case.

3 “The Doctor’s Job” Symptoms Symptoms Get them ALL Get them ALL Write them ALL Write them ALL Make it understandable Make it understandable Physical Exam Physical Exam Test all reported symptoms Test all reported symptoms Write down all test results Write down all test results Make it understandable Make it understandable Diagnosis Diagnosis Diagnose EVERY Symptom Diagnose EVERY Symptom Write EVERY Diagnosis Write EVERY Diagnosis Make it understandable (use ICD-9 codes) Make it understandable (use ICD-9 codes) Treatment Plan Treatment Plan Make Treatment PLAN for EVERY Diagnosis Make Treatment PLAN for EVERY Diagnosis Write EVERY proposed treatment (aka “plan”) Write EVERY proposed treatment (aka “plan”) Make it understandable (use CPT codes) Make it understandable (use CPT codes) “Be Accurate, Honest, & Thorough”

4 Narrative MUST Include ► Injuries Diagnosed & Treated  ICD-9 (“9+”)  CPT (“Active”)  Prognosis for EVERY ICD-9  Complaints (“Symptoms”)  Treatments (“Treatment Plan”)  Intensity (“Intensive” = >3x/wk sometime during Tx Plan)  Duration (“Prolonged” = >30 days meds, >90 days active Tx)  Testing (“Positive”) ► Prior/Subsequent Injuries  Majority/Minority ► Medical Supplies Prescribed  Medical Supply  Medication  Ambulance ► Dental & Orthodontic Treatment ► Disfigurement ► Impairments  AMA Guides WPI  DUD  LOE ► Disability ► Depression/Anxiety ► TMJ ► LOE ► Future Medical  Probable (50-75% = 1x multiplier)  Definite/Certain (75-100% = 2x multiplier) Failure to Address Each & Every One of These Items Is BELOW Minimum Competency To treat PI Patients

5 How to Write a Narrative Report ► Get all the SYMPTOMS  Update Monthly to show Duration (“Prolonged”) ► Make all the DIAGNOSES  Update Monthly to show Duration (“Prolonged”) ► Show the positive EXAM TESTS  Update Monthly to show Duration (“Prolonged”) ► Show all your TREATMEMTS  Update Monthly to show Duration (“Prolonged Active Tx”)  Update Monthly to show Intensity (“Intensive”)

6 Throw OUT… ► Your OLD Intake Forms ► This is all you need ► Stop doing “Accident Reconstruction” ► You are a DOCTOR. Be a GOOD one. ► Symptoms – Diagnosis – Exam – Treatment are a four-leg chair. Remove any one of these essential “legs” of your records and the chair is unstable.

7 The Symptoms Form should be filled out like this Blacken in all the boxes Do not make check marks Do not make X’s On re-exam days, explain to patient to check any symptoms they are experiencing “intermittently”, even if he/she is not experiencing them at that moment in the office. Otherwise, your paperwork is not accurate. This is easy to read from a 4 th or 5 th generation photocopy, which is what the claims adjuster looks at when deciding how much to give the patient in the PI settlement.

8 The Diagnosis Form Must by Filled In Like This Note the ICD-9 Codes are on it

9 The Doctor must give a diagnosis for every injured body part. There are 5 “body parts” in each body area. (1)Bones (2)Tendons (3)Ligaments (4)Muscles (5)Nerves

10 The Doctor must make ALL Diagnoses the patient has… (1)Not just chiropractic ones (2)Not just those he treats ALL of them Be Accurate, Be Truthful

11 Use this form to document the treatment to be delivered to the patient. This form tells Colossus both your in-office treatment and your patient’s home treatments.

12 CPT Codes This form contains CPT codes for 2 reasons. It helps the office biller work more quickly AND helps the Colossus data entry person work more quickly to settle the claim. Keeping good medical records makes the claim adjuster and all attorneys’ jobs easier because they have all the “facts” to know what is wrong. CPT Codes This form contains CPT codes for 2 reasons. It helps the office biller work more quickly AND helps the Colossus data entry person work more quickly to settle the claim. Keeping good medical records makes the claim adjuster and all attorneys’ jobs easier because they have all the “facts” to know what is wrong.

13 Symptoms, Exam, Diagnosis, Tx Plan… Doctor, this is your job. Do it well. Be accurate in your RECORDS because that is what adjusters and lawyers look at (not what is in your head.)

14 Here is an example of BAD use of my forms Symptoms = Low Back Pain Diagnoses for Low Back = NONE Treatment for Low Back = a lot Does this make sense?????

15 Here is another example of BAD use of my forms Patient reports Symptoms of Anxiety No Anxiety Diagnosis Treatment Prescribed for Condition with No Diagnosis

16 Please… Be GOOD Doctors Be Accurate Be Honest Be Thorough

17 Steven C Eggleston, D.C., Esq. Attorney at Law 2601 Main St., Suite 800 Irvine, California (877)


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