As one who's reviewed a ton of chiropractic records over the years, there always seems to be arguments about using the 0-10 scale to rate the intensity of a patient's pain.
For those of you who are not quantifying the patient's pain, know that it's REQUIRED. CMS (Centers for Medicare and Medicaid Services) states that this is required for every visit. They give options, such as the Verbal Numeric Rating Scale (verbal 0-10), a visual analog scale, pain questionnaires, etc. The easiest and fastest, I believe, is the VNRS. The problem, though, is …
Many patients exaggerate the intensity of the pain.
We even tell them..."10 is the worst pain imaginable..." and they still say it's a 10, or a 9, or an 8. I want to look at them and say, "Quit being such a baby." I've tried different ways over the years, like many of you have, much like you have. And they all sucked.
Until now. I've cracked the code.
I start the patient with Mild, Moderate and Severe. I tell them that we reserve Severe for patients who are at or on their way to the hospital. That gets 99% of the patients saying, well, it's not THAT bad. I suspect that the vast majority of new patients who see a chiropractor will fall into the moderate category.
Then I define the scale for them. If they say that condition 1 is mild, I ask for a number from 1-3. If it's moderate, gimme a number between 4 and 7. And for the very few who are severe and are heading to the hospital once they leave your office, that's an 8-10.
You want to document the intensity for each complaint you're treating. But there's another part of assessing pain, and that's the frequency of the pain. Many of you are using an EHR that makes you document Occasional, Intermittent, Frequent or Constant. I'm telling you right now...
Those do not work for us, and there's a very specific reason why (another story for another day). If you only see the patient once every few months, those ranges might be OK, but not for when the provider sees the patient more frequently, like chiros and PTs.
And quit documenting that all 8 symptoms have the identical pain rating for every visit. We both know that's BS.
Some of you are thinking, “Well, I'm a cash-practice and these Medicare rules don't apply to me.” Well, I've got news for you.
YES. THEY. DO.
Don't think of CMS (Centers for Medicare and Medicaid Services) as simply Medicare. They are the FEDS. They create the rules for documentation and billing for EVERYONE, even if you never touch a Medicare patient in your entire career. Most, if not all, insurers are following the CMS requirements. Most, if not all, state boards are following the CMS requirements.
So, if you're mad at me, I ask you...
Is your anger MILD, MODERATE or SEVERE?