Documenting PART During Routine Office Visits

The PART Process initials are an acronym for the required elements of examination that quantify the existence of a subluxation to meet Medicare requirements. The elements of PART are Pain, Asymmetry or Misalignment, Range of Motion Abnormalities, and Tissue Tone Changes. These elements are generally present in the initial examination by the chiropractor at the beginning of an episode of care. Therefore, the subluxation is established during the initial visit of the episode for that treatment plan.

There is some discrepancy in the language published by the Center for Medicare and Medicaid Services (CMS) vs. the language published by many Medicare Administrative Contractors (MAC) regarding the requirement to demonstrate PART on each subsequent visit of an episode of care. However, because the elements of PART are usually included in standard objective findings during a subsequent visit anyway, it’s a simple way to better document those findings day to day. Therefore, we recommend that you not only include the changes since the last visit in the objective findings but also document 2 of the 4 elements of PART, one being Asymmetry or Range of Motion. The following table illustrates the thought process or considerations that may help in document PART on a routine visit basis.

Documenting PART During Routine Office Visits
P Pain
  • Pain can be expressed in pain scale numbers or illustrated as painful upon palpation
  • Pain assessments should include quality descriptors
A Asymmetry/Misalignment
  • Asymmetry may be assessed each visit with updated segmental listings
  • Posture may be reassessed each visit with specific notations
  • Comment on how these assessments of asymmetry and posture differ from the previous or initial visit
R Range of Motion
  • Assessment of regional or segmental range of motion (ROM) limitations should be noted in your findings
  • ROM may be assessed manually or with a digital goniometer
  • Asymptomatic, but compensatory regions may be assessed and documented
  • Document changes in ROM from visit to visit to show progression or lack thereof
T Tissue Tone Changes
  • Palpatory tissue and tone changes may be described as hyper- or hypo- tonicity with changes noted from visit to visit
  • Spasticity may be documented when present
  • Grading these changes as mild, moderate, or severe can help document the patient’s improvement, or lack thereof