The care you render to your patients requires precision. Your examination, manipulation and treatment plan require precision; however, precision in your diagnosis is often overlooked.
The diagnosis you render reflects your knowledge, education and experience. An unspecified diagnosis lessens your reputation and your profession. The success of precision chiropractic care — and patient care as a whole — hinges on a critical factor: precision in the diagnosis.
The foundation of effective treatment
The International Statistical Institute adopted the first international classification of diseases in 1893.1 In the following years, the classification became known as the International List of Causes of Death and ultimately as the ICD. The ICD contains a description of all known diseases and injuries. Every country that subscribes to the ICD system uses it in various ways. In the U.S., the ICD system is used to evaluate the medical necessity of care, the methods of care and ultimately reimbursement. In 2015, the World Health Organization (WHO) released the tenth revision to the system, ICD-10. On Oct. 1 of each year, WHO releases revisions, modifications and deletions to the list, which reflects increased data and technology. The list has grown to more than 74,000 codes. On Oct. 1, 2024, the ICD-10-CM codes updated for fiscal year (FY) 2025 included 252 new codes, 36 code deletions and 13 code revisions.2
The diagnosis is the cornerstone of patient care. It is the first line of communication with others of your analysis and from which all subsequent decisions are made, from treatment plans to lifestyle adjustments. Inaccuracies or a lack of specificity at this stage can lead to ineffective treatments, decreased outcomes and increased healthcare costs.
The role of technology in enhancing diagnostic precision
Although technological advancements have significantly improved the precision of diagnostics, many DCs are scrutinizing the return on investment of owning an X-ray machine. However, not owning an X-ray machine does not preclude you from reviewing past radiologic reports and imaging and ordering further radiologic diagnostic imaging when injury or examination findings indicate pathology or degenerative conditions. Thorough consultation, examination and imaging, when medically necessary, offer detailed analysis of the patient’s condition and provide insights into the cause.
Soon, artificial intelligence (AI) will further revolutionize diagnostics. AI can analyze vast amounts of data, identify patterns and predict outcomes with a level of accuracy that surpasses human capability. This early detection is crucial, as it opens the door to early interventions that can significantly improve patient outcomes. Assuredly, AI is currently being used by carriers to scrutinize your claims and documentation.
The human element: Expertise and judgment
While technology plays a crucial role, the importance of chiropractic expertise cannot be overstated. The interpretation of diagnostic tests requires a deep understanding of the biomechanics and kinetic chain and the clinical context. DCs must apply their knowledge and experience to ensure the data provided by diagnostic tools is accurately interpreted. Diagnoses of cervicalgia, dorsalgia and lumbalgia indicate neck pain, middle back pain and low-back pain respectively, and are considered unspecified interim diagnoses. Carriers view these codes as short-term diagnosis codes used until the true diagnosis can be interpreted by further testing. Specifically, these codes indicate the level of understanding you possess in your analysis of the condition. Ask yourself, why do they have neck, middle and lower back pain? In the answer, therein lies the true diagnosis.
The consequences of diagnostic errors
The consequences of imprecise diagnoses can be severe. The failure to diagnose properly is a leading cause of chiropractic medical negligence claims.3 These errors can occur at various stages, including during the initial assessment with inadequate consultation and examination, the interpretation of diagnostic tests and the communication of findings to patients.
Inaccurate diagnoses can lead to unnecessary treatments, exposing patients to risks without the likelihood of benefit. They can also result in missed opportunities for early intervention, particularly in cases where diseases are asymptomatic in their early stages. For patients, the emotional and physical toll of diagnostic errors can be immense, leading to a loss of trust in the chiropractic method of healthcare.
Final thoughts: The need for ongoing education, collaboration and desire for accuracy
To achieve the highest levels of diagnostic precision, continuous education and collaboration among the chiropractic profession is essential. The rapid evolution of diagnostic methods and coding means chiropractic providers must stay informed about the latest diagnostic tools, techniques and available diagnosis codes. Precision in the diagnostic tools and reporting of conditions with the appropriate codes will lead to greater success in the treatment of our patients.
MARIO FUCINARI, DC, is a Certified Professional Compliance Officer, Certified Physician Practice Manager, Certified Insurance Consultant and a Medicare Carrier Advisory Committee member. He is the author of several publications and educational manuals. As a member of NCMIC, Foot Levelers and ChiroHealthUSA Speakers Bureau, he travels throughout the year sharing his chiropractic expertise and insights about documentation, billing and coding issues. Questions and speaking inquiries can be sent directly to Fucinari at AskMario.com or via email at doc@askmario.com.
References
- Raminani SR. International Classification of Diseases. Encyclopedia Britannica. February 2024. https://www.britannica.com/topic/International-Classification-of-Diseases. Accessed September 6, 2024.
- 2025 ICD-10-CM. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2025-icd-10-cm. Accessed September 6, 2024.
- Medical negligence: Why you need to be covered. NCMIC blog. December 2021. https://www.ncmic.com/insurance/malpractice/risk-management/medical-negligence-why-you-need-to-be-covered/. Accessed September 6, 2024.
