There may be instances in your practice where it makes sense to dismiss a patient. This can be a delicate situation. When it comes to patient dismissal, the Wisconsin Medical Society recommends that health care providers give patients at least 30-days’ notice to prevent a claim for patient abandonment. However, abandonment is usually only an issue with solo, highly specialized professionals who do not have many peers and providers who are providing a patient a course of treatment that cannot be interrupted for the time it would take to locate and replace a provider. You should notify your patient in writing.

Notification letters should include a medical records release form so that patients may request a timely transfer of their records to their new treating provider.

Letters should contain the following information:

•  Reason for termination—A specific reason for termination is not required. Under certain circumstances, it is acceptable to utilize the following catchall phrases: “inability to achieve or maintain rapport,” or “the therapeutic practitioner-patient relationship no longer exists.”
• Effective date—The effective date of termination should provide the patient with a reasonable time period to establish a relationship with another practitioner. The relationship can be terminated immediately under the following circumstances:
  • The patient has terminated the relationship.
  • The patient or a family member has threatened the practitioner or staff with
    violence, or has exhibited threatening behavior.

SOURCE: http://www.thedoctors.com/knowledgecenter/patientsafety/articles/CON_ID_000326.

Sample language for a patient notification letter:

Dear:
I find it necessary to inform you that I will no longer be able to serve as your Chiropractor.
As you [may] require Chiropractic care in the future, I recommend you promptly find another Doctor of
Chiropractic to care for you. You can contact your insurance for the names of chiropractors who are
accepting new patients. You will need to do this as soon as possible (any future appointments have been
cancelled). Enclosed is an authorization form that permits me to send your chiropractor a copy of your
medical records.
Please complete the form and return it to me.
Sincerely yours,

What is the difference between dry needling and acupuncture?

The primary difference between acupuncture and dry needling is that acupuncture treats for the purpose of altering the flow of Qi (or energy) along traditional Chinese meridians while dry needling follows evidence-based guidelines, recommended “point” locations, and dosages for the treatment of specific conditions.

In Wisconsin, “acupuncture” is defined in Wis. Stat. 451.01 as promoting, maintaining, or restoring health, or diagnosing, preventing, or treating disease based on traditional Oriental medical concepts, using methods like inserting needles, moxibustion, or other therapeutic techniques.

According to the Mayo Clinic, dry needling is: a technique used to treat and manage pain, particularly musculoskeletal pain, by penetrating the skin with a thin needle to target and inactivate trigger points in muscles, potentially reducing pain and restoring function.

What changed to allow Wisconsin Chiropractors to be able to perform dry needling?

At its meeting in August 2020, the CEB directed Board legal counsel to determine if there were any laws or rules that would prohibit chiropractors from offering this therapy. During its October 29th, 2020 meeting, the CEB considered information provided by legal counsel and approved a motion that states “Move to affirm the Board’s interpretation that dry needling is an adjunctive service that falls within the scope of practice for chiropractors.”

Will the CEB be providing further guidance on their motion to allow chiropractors to perform dry needling?

The CEB also approved a motion in October 2020 to direct the Board legal counsel to draft a formal “guidance document” outlining the specific legal and rationale for their decision. The Board never followed up on this motion and the staff at DSPS never provided this guidance.

Did the CEB set a minimum training standard that chiropractors need in order to perform dry needling?

The Board did NOT set a minimum training standard as part of their motion to approve dry needling for chiropractors, but Chir 6.02 (6) of the Wisconsin Administrative statues states that it would be unprofessional conduct when “Performing professional services inconsistent with training, education or experience.” The WCA strongly urges anyone looking to perform dry needling to obtain proper training.

Can a chiropractor delegate dry needling to a chiropractic technician?

No. While technically, a CT can be delegated the performance of an adjunctive service, in talking with members of the CEB, this is NOT their intention. The WCA recommends that chiropractors do NOT delegate dry needling to CT’s.

How should chiropractors code dry needling procedures?

The WCA strongly recommends that chiropractors who wish to perform dry needling take a training course that includes the billing and coding aspects of the service. Please note that WCA CE courses on dry needling will include these aspects.

The codes for billing dry needling services are as follows:

• 20560 – Needle insertion(s) without injection(s), 1-2 muscles
• 20561 – Needle insertion(s) without injection(s), 3 or more muscles

The number of needles used and the time spent with the patient are not part of the consideration of which code to use. Only the number of muscles involved in the procedure.

• Only one unit of this code can be billed per encounter.
• Can also be billed and performed on the same day as an adjustment, massage, or manual therapy.
• May not be covered by insurance, asit is usually deemed “experimental and investigational.”

While you can bill these codes for dry needling services, please know that they may not be covered because they are often deemed “experimental and investigational.” If not covered by insurance, a typical charge at time-of-service may be $100 per 1-hour session ($25 for 15 minutes of service). Please note that you will need to set your own fees based on your business situation.