Coding the Kinetic Chain Disruption
As chiropractors, we understand that a segment’s mobility dysfunction will affect proximal and distal segments to the first segment.
Chiropractors treat a variety of conditions, but the majority of the complaints we treat are musculoskeletal disorders. People who seek chiropractic care do so 64% to 86% of the time for spine-related needs (Coulter et al., 2002). Kinetic chain disruptions are a common theme when considering the causation of what we treat. However, conveying disruptions of the kinetic chain poses a challenging problem when assigning diagnosis codes to our patients.
The kinetic chain concept was first introduced by Franz Reuleaux in 1875. Reuleaux proposed that rigid, overlapping segments were connected via joints, creating a system whereby movement at one joint produced or affected movement at another (Andrew, 2002). As chiropractors, we understand that a segment’s mobility dysfunction will affect proximal and distal segments to the first segment.
I will admit that I am a people watcher. I am intrigued by watching the gait of people in public and analyzing where the dysfunction is located, which affects the gait pattern. Admit it, don’t you do the same? Chiropractors are hard-wired to observe dysfunction.
When we communicate the causation of a condition to a third party, we often must assign an alphanumeric code that best describes our assessment. Currently, over 74,000 diagnosis codes are available to us. We are tasked to be as specific in our diagnosis as possible. Code what you know but be as detailed as possible when using codes. Signs and symptom codes are only to be assigned if those codes represent the highest level of specificity known by the provider. Therefore, using unspecified codes, such as cervicalgia, low back pain, and muscle spasms, is discouraged. They do not tell the entire story.
The “kinetic chain” of our thought process starts at the consultation. The consultation tells us what the problem might be, and the examination determines the condition. The analysis used in medical decision making tells us what the situation truly is, while the diagnosis tells others what the disorder is. Diagnosis codes justify our treatment based on the information found in the patient record and on the claim form. The kinetic chain of thought is known as medical necessity. If one segment of the thought process is misaligned, the medical need for care is not supported. The documentation and coding of medically necessary care must therefore be specific.
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Article written for The American Chiropractor by Mario Fucinari, DC, CP CO, CP PM, CIC
September 1, 2023
