Overview

Chiropractors with this status can respond to requests from attending providers about diagnosis or treatment planning.

Chiropractic Consultant Program overview

The Chiropractic Consultant Program is a second opinion program that serves as a resource to attending providers and claim staff for Washington’s State Fund and self-insured employers.

Chiropractic consultants have completed at least 5 years of clinical practice experience and have additional continuing education training covering:

  • Occupational health best practices
  • Adjudication issues in workers’ compensation
  • Conservative care options for common work injuries
  • Functional improvement including return to work
  • Documentation and reporting best practices

Referral for consultation or second opinion

Referral for any consultation examination, including to Chiropractic Consultants, does not require prior authorization. However, attending providers should notify the claim manager of a referral for any second opinion consultation. Timing can be an issue if a claim manager is already scheduling an Independent Medical Examination (IME), the claim has been closed, or if a claim re-opening is pending.

Any attending provider can request a second opinion about diagnosis or treatment from approved Chiropractic Consultants located throughout Washington State. Consultants are a resource for clinical guidance regarding:

  • Active Rehabilitation for Work-related Low Back Conditions
  • Additional insight for conservative care, return to work, and/or injury rehabilitation options
  • Advice for deciding on a specialist referral or advanced diagnostics (including imaging)
  • Assistance with stalled progress
  • Issues leading to complications or disputes in a claim, or
  • Guidance for a non-emergency diagnostic or therapeutic conundrum

Referring for services 

Services

When to get a second opinion

Prior authorization is not required, but timing can be an issue. The attending doctor should notify the claim manager of this action.

Required when Attending Provider
discretion when:
May not be referred by the
attending doctor if:
  • Before 120 days of conservative care have passed or
  • 20 conservative care visits with an attending provider have been made
  • A complication, controversy or dispute arises over the treatment of injured worker or
  • The insurer requests a consultation exam.
  • The worker's accepted condition presents a diagnostic or therapeutic problem or
  • Clinical guidance on conservative care, return to work or injury rehabilitation or
  • Assistance with stalled progress or
  • Advice on specialist referrals or advanced diagnostics
  • An independent medical exam (IME) has already been requested by the claim manager or
  • Claim reopening is pending or
  • Claim is closed

Services Offered by Chiropractic Consultants

L&Is Chiropractic Consultants may provide a variety of useful services for attending providers who need help or guidance with an injured worker. Claim managers or Occupational Nurse Consultants may sometimes recommend that an attending provider obtain a Chiropractic Consultant evaluation to address questions on the claim. Attending Providers may refer patients or set up telephone peer-to-peer consultation. Common services outlined:

  • Physical examination
  • Care and treatment planning
  • Work-relatedness or causation of a condition
  • Guidance with return to work and/or resolving employer issues
  • Guidance with advanced diagnostics, specialist referral or consultation
  • Closing examinations (including permanent disability ratings if the Chiropractic Consultant is also on the department’s Approved Examiner List)
  • Informal occupational health advice (some consultants in your community may be willing to volunteer to coach providers through using available best practices resources to optimize your ability to care for injured workers)
Becoming a Consultant

How to apply

If you meet the requirements shown below, you may apply at any time by sending a Chiropractic Consultant Application (F245-393-000) and your documentation to:

L&I Provider Quality and Compliance
P.O. Box 44322
Olympia, WA 98504-4322

Requirements for becoming a Chiropractic Consultant

  • Member in good standing in the L&I Medical Provider Network (MPN) with an active MPN provider number.
  • Maintain current license to practice in Washington state with:
    • Minimum of five years practice experience including at least two years in Washington state.
    • Minimum of eight hours per practice week devoted to patient management during the previous year.
  • Proof of completion of:
    • At least 50 hours of post-graduate continuing education in the subject areas below, with at least 30 of those hours completed in the year before applying:
      • Conservative care resources and other education created by the Policy, Practice and Quality subcommittee of the Industrial Insurance Chiropractic Advisory Committee (IICAC)(at least 25 hours) 
        AND other education to fulfill the remaining hours from any combination of:
      • Patient evaluation (such as examination, diagnostic assessment, imaging).
      • Patient care (such as orthopedic, neurological, rehabilitation).
      • Chiropractic technique (maximum of 10 hours).
      • Other L&I approved or sponsored occupational health-related provider training
    • At least seven hours within the past two years from the Chiropractic Consultant seminars.
  • Agree to maintain high quality clinical documentation:
    • Consistent with policies and requirements as published in L&I’s Medical Aid Rules and Fee Schedules.
    • Informed by L&I’s Documentation Best Practices
    • Timely and complete reporting (including ROA, APFs, 60-Day, closing examinations and special reports)
  • Have obtained consultations for accepted L&I claims managed in the previous two years when clinically indicated and prior to 120 days of conservative care.
Renew

Renewal requirements for Chiropractic Consultants

You must attest every two years that you meet ongoing requirements. Failure to meet these ongoing requirements can result in loss of Chiropractic Consultant status. L&I will mail you the attestation form during the fall of odd numbered years. We will perform random audits to 5% of renewal applicants, who will be asked to submit their continuing education documentation.

The requirements for renewal are:

  • Maintain good standing with the L&I Provider Network
  • Have a current, unrestricted license in Washington state.
  • Complete 60 hours of continuing education over two years in these specific subjects:
    • Chiropractic treatment technique (up to a maximum of 30 hours)
    • Patient evaluation and care (such as Conservative Care Resources)
    • Occupational health best practices or other L&I approved health care training
  • CE must include at least seven hours every two years of L&I sponsored or approved training for chiropractic consultants. This training is critical to understanding L&I processes, reporting requirements and new policies.
  • Agree to maintain high quality clinical documentation:
    • Consistent with policies and requirements as published in L&I’s Medical Aid Rules and Fee Schedules.
    • Informed by L&I's Documentation Best Practices.
    • Timely and complete reporting (including ROA, APFs, 60-Day, closing examinations and special reports).
  • Obtain consultations if clinically indicated, and prior to 120 days of conservative care for accepted L&I claims.

Independent Medical Examiner Program

Chiropractors with at least two years experience as chiropractic consultants, who have also taken the L&I Chiropractic IME Seminar may apply to become an independent medical examiner (IME). IME doctors are called on by the department or self-insured employer to provide an independent assessment of the patient’s status, including rating for any permanent impairment.

Visit Becoming an IME Provider for more information.

Billing

Billing For Chiropractic Consultation Services

Consultations are second opinion encounters billed using CPT Evaluation and Management consultation codes. Like other E/M codes, DCs who have become approved Chiropractic Consultants may bill any of the four lower levels of consultation services for patient encounters. In addition, consultants may bill for case conference services associated with second opinion consultations.

Communicating your role as a Chiropractic Consultant:

In addition to your active clinical practices, Chiropractic Consultants serve as second opinion evaluators for their local health care communities and the workers’ compensation system. IICAC has consistently worked with the department to oversee the development of training resources and mentorship for DCs interested in providing second opinions.

The Chiropractic Consultation program is not an academic or clinical credential and should not be portrayed as such. Additionally it is not to be used as an explicit recruitment tool for new or transferring patients. However, IICAC has developed language that may be used with your practice information (websites, curriculum vitae, advertisements) regarding your role and services as a chiropractic consultant:

  • Listing on vitae, business cards, etc:
    • Chiropractic Consultant, Department of Labor & Industries
    • Dates, years of program participation
    • Links to L&I webpages for the Chiropractic Consultant Program
  • Information that can be included in promotion (advertising, website, fliers, etc):
    • Copies of information on L&I's Chiropractic Consultant webpages. Language within this overview page, listing of services provided
    • Information about contacting you for making a second opinion referral
    • Links to or copies of information on L&I's Chiropractic Consultant webpages (e.g., Attending Provider referral form (F252-098-000))
  • Sample introductory letter to colleagues about your role and services as a chiropractic consultant.