What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms.


There is no question that these adjustments would be considered clinically appropriate, Medicare may not consider this type of treatment to be medically necessary without some sort of exacerbation or new condition. However, CMS does state that chronic subluxations are not considered maintenance care. Documentation of functional improvement is the difference.