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Exam Guide

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D.C., C.A. & C.T.

William Risley, D.C.
Marge Risley, R.N., M.A.

Exam Guide Cover


REVISED EDITION - Now includes over 150 additional pages of important information for the chiropractic office!


The Exam Guide has 25 pages of the newest CPT coding, and E/M Codes, to "walk you through" the maze of complicated procedures for proper and maximum reimbursement.

This section has been contributed by one of the experts in Office Management/Billing Procedures.

It includes precise and pertinent extracts from the big books, condensed for use in the chiropractic office.
  • CPT CODES: E&M codes (Evaluation and Management) and how to use them.

  • NEW 98925-29 manipulative treatment code

  • NON-CPT CODES (HCPCS-LEVEL 2) for Supplies, Foot Levelers, Supplements, Etc.

  • ICD-9 Diagnostics codes pertinent to chiropractic.



  • Whartenburg pinwheel use - the complete description - complete with dermatome charts, arms and legs. Nine (9) neurological procedures. Cranial nerve testing.

1. We recommend sterilization of the pinwheel after using the instrument on each patient. A 10% solution of bleach or actual autoclaving procedure should be used.

2. Purchase two (2) pinwheels for simultaneous use on both extremities - arms and legs. We can not over emphasize the importance that equal pressure be applied to each arm or leg, and two pinwheels used at the same time will enhance this equal pressure requirement. It is also much easier for the patient to make the determination that one side is sharper or duller than the other, when the extremities are tested together.

3. The time may come, in court, that you may be seriously questioned about the amount of pressure used on each extremity with this pinwheel. You must therefore hold the pinwheel in the manner pictured and in the same manner pictured and in the same manner with both hands, should you use two at once. See illustration below.
Pinwheel Use

... and more!
Pinwheel should pivot freely between thumb and index finger


  • Fifteen additional orthopedic tests - their descriptions, and recommended use in narrative format. Twenty - nine (29) total.



Lasegue's test is also referred to now as the STRAIGHT LEG RAISE TEST. When this test is positive, it is generally suggestive of an inflammation of the sciatic nerve as it comes out of the low back or lumbar spine. The patient may experience low back pain or he may experience an "increase in intensity of pain" along the back of the leg (sciatic nerve route). Low back pain only, may suggest a low back strain or sprain as compared to a disc lesion.

The patient is lying on his back as pictured. Keep the leg straight, and passively raise it as far as possible. Most patients can have the leg raised almost straight up (90 degrees) without major pain. The patient with "sciatica" will experience pain early in the movement of the leg. It is important that you document at what level the patient's leg raise maneuver caused him pain. It is generally recorded as 35 degrees, 65 degrees, or such. Do the other leg also.

Photo of doctor and patient doing leg raise test

Lasegue's/Straight Leg Raise Test was:
Negative ______
Positive _____
Comment: (Leg pain, Right low back pain, etc., at ______ degrees)

Diagnosis code:
847.2 lumbar strain/sprain
722.1 Prolapse or protrusion of a disc
724.9 Nerve root compression
724.10 Sciatica


"Lasegue's Straight leg raise was positive for an increase in sciatic neuralgia to the affected leg, at ___ degrees. This is suggestive of a disc lesion or other pathology in the lumbar spine of this patient."
"Lasegue's straight leg test was negative for an increase in sciatic pain or low back pain."


  • Temperature Gradient studies, a new and remarkable adjunct for objectifying the need for an adjustment and the locations of subluxation.

  • The "How to" description for in-office use of Doppler ultrasound and Pulse Volume Recording to provide scientific documentation to prove what you do is correct. Strong pre and post-adjustment evidence of restoration of blood flow to the brain.
Graphs of pre- and post adjustment blood flow

  • Thoracic outlet testing with Doppler and the plethysmograph. Documented, hard-copy evidence in support of chiropractic effectiveness - a must for the courtroom.

  • Updated laboratory values. Suggested tests for each injury and what they mean. There are also suggested follow-up procedures for the doctor. These are tests particularly designed for chiropractic practice.

The text is designed for use also by the Chiropractic Assistant or Technician to remove some of the workload from you as the doctor, and still provide competent and defensible office procedures. It is also a simplified guide for the doctor.


A partial list of the contents:
* Multiple (29) cervical and lumbar orthopedic tests and their descriptions.

* Range of motion testing and measurements of arms and legs.

* How to test for cranial nerves.

* How to test manually for thoracic outlet syndromes. How to test for thoracic outlet syndromes with Doppler and plethysmography.

* Where to find 10 different arterial pulses.

* Where, why and how to listen for bruits.

* Five (5) deep tendon reflexes (DTRs) to test for, where to find them and how to test them.
* Use of a dynamometer, goniometer, pinwheel, Doppler, plethysmograph and how and why to do chest measurements.

* Foot/ankle and toe strength measurements and why.

* Ready-made examination forms you may copy for use in your office.
* A complete sample narrative report, utilizing tests presented in the text.

* A complete impairment rating - sample report.

* Paragraph descriptions of each procedure for insertion into your narrative report.

* How to do George's test (stroke screening).


Included in the Examination Guide are Case History Forms that you may copy and your CA/CT can use to save you time.

Forms include:
  • Car accidents case history
  • Car accident exam form
  • Neck pain case history
  • Neck pain exam form
  • Low back pain case history
  • Low back pain exam form
  • Blood vessel disease case history
  • Blood vessel disease exam form
  • Low blood sugar screening symptoms
Additional information includes:
  • Ragland's maneuver and what it means.
  • A 280 word glossary of terms common to chiropractic.
  • Extensive list of laboratory normals... updated.
  • How to admit patients into the hospital.


The new revised edition of The Examination Guide for the Chiropractic Health Provider is an invaluable resource. Order yours today!

Examination Guide for the Chiropractic Health Provider - Hard Copy     $69.95


Medical Services Company
William B. Risley, Sr., D.C.
Margaret J. Risley, R.N., M.A., M.S.N.
10475 N 105th Way
Scottsdale, AZ 85258
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