By John Davila, DC, FICC
Editor’s note: Dr. Davila is one of the featured speakers at the 2026 ICS Chicagoland Fall Convention. Learn more and register for the convention here.
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For many doctors of chiropractic, the term “medical necessity” triggers a mild sense of dread. We associate it with insurance claim denials, tedious audits, and the fear of giving auditors more information than is necessary. But the reality is that anchoring your documentation in medical necessity is not a bureaucratic hurdle—it is the best clinical tool available for running an effective, legally sound practice.
When we shift our documentation mindset from merely “taking notes” to specifically defending why the care rendered today is necessary, we protect our practice, improve the standard of patient care, and streamline our daily workflows.
Why is “Medical Necessity” Your Best Ally?
Medical necessity dictates that the care you provide must be intended to correct or improve a specific functional loss tied to a neuromusculoskeletal condition, and there must be a reasonable expectation that the patient will see measurable improvement. The key here is focusing on the actual goal of care. Do you want to measure improvement of pain or an activity of daily living (ADL)?
By detailing this in every chart note, you stop relying on “less is more” approaches and instead start giving reviewers precisely what they need to approve payment. Here are three actionable ways to leverage medical necessity to elevate your notes.
Start with the P.A.R.T. Framework
Whether subluxation is identified via X-ray or physical examination, its presence must be documented objectively. Auditors universally rely on the P.A.R.T. criteria to support the claim of a subluxation being present as follows:
- Pain or tenderness (evaluated by location, quality, and intensity)
- Asymmetry or misalignment (identified at a sectional or segmental level)
- Range of motion abnormality (segmental)
- Tissue/tone changes in contiguous soft tissues
Tie the Subluxation to the Symptom
A common compliance pitfall is documenting a subluxation at one vertebral level while the symptoms are described in an entirely unrelated region. Your documentation must prove a causal relationship. If a patient presents with cervicogenic headaches, your notes must clearly tie the symptoms (e.g., pain and stiffness) to the specific spinal level of the cited subluxation.
Every spinal region billed must be supported by the signs and symptoms present on that specific date of service. The documentation of a complaint in each region is usually one of the details that get lost in the process of creating the initial need for that region to be examined.
Focus on Objective Functional Goals
Medical necessity requires that the patient is progressing toward functional improvement. If a patient’s clinical status plateaus and no further measurable functional improvement is expected, the care shifts into maintenance therapy, which is generally not covered by insurance.
To keep your notes effective, document clear, measurable goals (such as an improved Oswestry Disability Index or increased range of motion) and record how the patient’s functional deficits are changing due to your treatment. This proves to any third-party reviewer that the patient is actively improving.
In our class we will take this point one step further. We will discuss how and why you should place your objective functional goals and swap them with your pain-based goals. The process of making the swap to having functional goals in the subjective portion of your documentation is actually very easy to do and make proving necessity much easier.
Where Does It All End?
Care that goes on for years without a stated and measured outcome will create a billing profile that you can’t document your way out of. The fix for this problem is to create proper treatment plans in order to manage what your profile looks like before your billing goes out. If you can do this properly, you can successfully transition patients from active care to wellness care and mitigate the chances of getting audited.
The Takeaway for Your Practice
Writing effective notes doesn’t require writing a novel. It requires painting a clear, encounter-specific picture of what you did, why you did it, and how it helped the patient on that specific day. By embedding medical necessity into the core of your SOAP notes, you safeguard your practice against audits, maximize reimbursements, and ensure your patients receive the highest quality of active, goal-oriented care.
