PART and ROV
The PART process, an examination method intended to quantify the presence of a subluxation for Medicare, has been used for over two decades. The application of PART, as noted below, is critical in the initial visit of an episode of care to formulate the basis for medical necessity. However, when documenting the evaluation on an ROV, the components of PART provide a useful guideline to record the findings. Remember, the object of objective is to document comparison of the findings to the previous visit. This data maintains the consistency of basic findings from visit to visit and uses a nationally accepted format.
PART is not required every visit, per Medicare, and is never specifically required outside of Medicare; but this simple process can be valuable as a documentation standard for all patients. Medicare’s minimum PART findings require at least 2 elements, one from the “A” or “R” in PART to aid in proving the existence of a subluxation and medical necessity. Documenting these findings helps cover your bases and supports your Assessment of the day’s visit. You must document these findings for each region treated to show both clinical appropriateness and medical necessity.
The two most common and accepted forms of evaluation of Spinal Subluxation(s) in the profession are Static and Motion palpation, 89.2% and 86.5% respectively. Therefore, it seems both easy and familiar for providers to include these minimum evaluation techniques in their records. How do these techniques relate to PART?
In the ROV-O’s most basic form, the doctor can show changes in the A.R. of PART since the previous visit with respect to:
- Patient’s condition
- Treatment effectiveness
What does this look like in your records?
|PART Minimum for ROV-O
||Static Palpation: Left rotated C7, mildly less prominent or severe
|Range of Motion (segmental or area, C5-6 or Cervical area)
||Motion Palpation: segmental motion restriction: C7 right rotation, mildly less severe restriction
|Doctor’s objective note on treatment response not necessary but may help
||Noted decreased severity C7 VSC* post CMT
|Medicare requires a primary VSC*
||Primary VSC* C7
||*Vertebral Subluxation Complex
In the example above, the provider determined the A.R. of P.A.R.T. simply from palpation. It allows a provider to quickly arrive at A and/or R during each visit using different senses or tools:
- Other Testing: standardized objective data with interpretation from specialists. Note: this is the S of the expanded “PARTS”
- Radiological Imaging (X-rays, CT, MRI with or without contrast, US Doppler studies, Dexa Scan)
- Neurological: NCV, Needle EMG, Evoked potentials, Reflex testing, Sleep Study)
- Blood testing (CRP, Ferritin, Transferrin, RA factor, CBC with diff, Thyroid)
- Pulmonary Function Tests
Note: for some of the above, connect the visceral/vascular problem to the spinal area and segment(s) of complaint
PART on Observation
The example above reviewed the A and R through palpation; next, explore these elements using only Observation. Begin the patient evaluation the very moment you see him/her. Below are some examples that may be appropriate for the Objective section of the daily note:
Observation of Asymmetry
- Seated position, T-L-S leaning moderately less to the left.
- Weight bearing, increased head tilt to the right, 45 degrees.
- Improving gait, a bit more weight bearing on Rt leg, mild pain with less (approx. 30 degrees) Lt lumbar antalgia.
Observation of ROM
- Increasing Rt shoulder ROM, up to 90 degrees with mild pain while getting on and off the treatment bench.
- 25% increase cervical Lt rotation ROM with mild pain at C6-7 (Did the patient turn his/her neck more to talk to you while you were to his/her side, or did s/he turn his/her body?)
- Mild decrease T L S flexion with mild pain local at Rt SI (Could the patient bend forward to pick up the keys you accidentally dropped? Patients usually want to be helpful even when they are in pain.)
Observation of Asymmetry
- Mild Rt T-L-S convexity, decreasing severity, apex at L3
Observation of ROM
- 50% decrease Right Lateral Flexion ROM T-L-S spine, no pain, maximal restriction at L3
- 25% decrease Lumbosacral extension ROM, elicits mild-moderate pain at L5-S1.
These are just examples of things to consider. They are not intended to be copied and pasted into your records. Furthermore, these examples use AR of PART only to meet the minimum requirements. Other minimum options are PA, PR, RT, AT, of PART.
Tell the story of your patient’s progress with solid documentation of objective findings on a day-to-day basis. From there, medical necessity is sure to follow.
 Beliveau et al) “The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided,” Chiropr Man Ther 2017; 25(35):1-17