There is a computer program called Colossus which is being used to determine what is reasonable and necessary treatment, especially in personal injury claims. CSC, the producer of that program states:
"Colossus® is an expert system for assisting adjusters in the evaluation of bodily injury claims. Colossus provides a framework for evaluating injuries, treatment, resolution, impairment, and general damage settlements. Colossus helps adjusters to reduce the variance in payouts on similar bodily injury claims.
(It helps) adjusters quickly interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides the adjuster through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle.
So... a software program is now determining how (or if) claims will be paid. The good news is that this software utilizes the documentation you submit to make those determinations. You may recall the computer term GIGO (garbage in, garbage out)? The more complete your notes are, the better your office and client will be recompensed.
Lets review the components of a file that count towards getting the most "points" in the Colossus program:
1. Your notes must be legible.
2. Radiology report that notes a loss of normal spinal curvature.
3. Every visit documents the presence, and location of self-reported tenderness and muscle spasm, and the presence and location of tenderness and muscle spasm located by palpation during your exam. We ask the patient to use the 1-10 scale to grade the severity of their complaint(s). (1 = least, 10 = worst)
4. The file's notes and measurements document changes in head placement, or other postural changes, and any abnormal gait patterns. Things like "anterior head placement", "antalgia", or "lateral head tilt" are mentioned and tracked over time. Progress and resolution of these complaints is also tracked.
5. Changes in "activities of daily living" (ADLs) are noted and tracked over time. It is important to chart the impact of the injury on the patient's sleeping patterns, their capacity to work, and on their recreational activities.
6. The Diagnosis accurately describes the patient's condition and complaints, and that a complete diagnosis (and not just the 4 lines provided on the HCFA forms) is provided to the 3rd party. We send a separate diagnosis form along with the first bills, and all our HCFAs state that the "complete diagnosis" was provided separately.
All the above observations can be tracked with a simple Problem List. There is one provided in Dr. Mootz's article "Maximizing the Effectiveness and Efficiency of Clinical Documentation" (See Figure 6).
There are key things that need to be assessed and reported if the patient is experiencing them: muscle spasm, radiation of pain, dizziness, restrictions in movement, headaches, and visual disturbances.
If your patient is experiencing radiating pain, it may be useful to refer them for a second opinion to a neurologist or physiatrist. The Reports they generate will support your care plan and diagnosis.
You may also enjoy Dr. Arthur Croft's article on this topic: The "Colossus" Claims Program, and How It Affects You and Your Patients.