Texas Administrative Code
Title 22 - EXAMINING BOARDS
Part 3 - TEXAS BOARD OF CHIROPRACTIC EXAMINERS
Chapter 78 - SCOPE OF PRACTICE AND DELEGATION
Section 78.1 - Scope of Practice
Universal Citation: 22 TX Admin Code ยง 78.1
Current through Reg. 49, No. 38; September 20, 2024
(a) Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
(1) Board--The Texas Board of Chiropractic
Examiners.
(2) CPT Codebook--The
American Medical Association's annual Current Procedural Terminology Codebook
(2004). The CPT Code- book has been adopted by the Centers for Medicare and
Medicaid Services of the United States Department of Health and Human Services
as Level I of the common procedure coding system.
(3) Cosmetic treatment--A treatment that is
primarily intended by the licensee to address the outward appearance of a
patient.
(4) Incision--A cut or a
surgical wound; also, a division of the soft parts made with a knife or hot
laser.
(5) Musculoskeletal
system--The system of muscles and tendons and ligaments and bones and joints
and associated tissues and nerves that move the body and maintain its
form.
(6) On-site--The presence of
a licensed chiropractor in the clinic, but not necessarily in the room, while a
patient is undergoing an examination or treatment procedure or
service.
(7) Practice of
chiropractic--The description and terms set forth under Texas Occupations Code
§
201.002,
relating to the practice of chiropractic.
(8) Subluxation--A lesion or dysfunction in a
joint or motion segment in which alignment, movement integrity and/or
physiological function are altered, although contact between joint surfaces
remains intact. It is essentially a functional entity, which may influence
biomechanical and neural integrity.
(9) Subluxation complex--A
neuromusculoskeletal condition that involves an aberrant relationship between
two adjacent articular structures that may have functional or pathological
sequelae, causing an alteration in the biomechanical and/or neuro-physiological
reflections of these articular structures, their proximal structures, and/or
other body systems that may be directly or indirectly affected by
them.
(b) Aspects of Practice.
(1) A person practices chiropractic
if they:
(A) use objective or subjective
means to analyze, examine, or evaluate the biomechanical condition of the spine
and musculoskeletal system of the human body; or
(B) perform nonsurgical, nonincisive
procedures, including adjustment and manipulation, to improve the subluxation
complex or the biomechanics of the musculoskeletal system.
(2) Needles may be used in the practice of
chiropractic under standards set forth by the Board but may not be used for
procedures that are incisive or surgical.
(3) This section does not apply to:
(A) a health care professional licensed under
another statute of this state and acting within the scope of their license;
or
(B) any other activity not
regulated by state or federal law.
(c) Examination and Evaluation.
(1) In the practice of Chiropractic,
licensees of this board provide necessary examination and evaluation services
to:
(A) Determine the bio-mechanical
condition of the spine and musculoskeletal system of the human body including,
but not limited to, the following:
(i) the
health and integrity of the structures of the system;
(ii) the coordination, balance, efficiency,
strength, conditioning and functional health and integrity of the
system;
(iii) the existence of the
structural pathology, functional pathology or other abnormality of the
system;
(iv) the nature, severity,
complicating factors and effects of said structural pathology, functional
pathology or other abnormality of the system;
(v) the etiology of said structural
pathology, functional pathology or other abnormality of the system;
and
(vi) the effect of said
structural pathology, functional pathology or other abnormality of the system
on the health of an individual patient or population of patients;
(B) Determine the existence of
subluxation complexes of the spine and musculoskeletal system of the human body
and to evaluate their condition including, but not limited to:
(i) The nature, severity, complicating
factors and effects of said subluxation complexes;
(ii) the etiology of said subluxation
complexes; and
(iii) The effect of
said subluxation complexes on the health of an individual patient or population
of patients;
(C)
Determine the treatment procedures that are indicated in the therapeutic care
of a patient or condition;
(D)
Determine the treatment procedures that are contra-indicated in the therapeutic
care of a patient or condition; and
(E) Differentiate a patient or condition for
which chiropractic treatment is appropriate from a patient or condition that is
in need of care from a medical or other class of provider.
(2) To evaluate and examine individual
patients or patient populations, licensees of this board are authorized to use:
(A) physical examinations;
(B) diagnostic imaging;
(C) laboratory examination;
(D) electro-diagnostic testing, other than an
incisive procedure;
(E) sonography;
and
(F) other forms of testing and
measurement.
(3)
Examination and evaluation services which require a license holder to obtain
additional training or certification, in addition to the requirements of a
basic chiropractic license, include:
(A)
Performance of radiologic procedures, which are authorized under the Texas
Chiropractic Act, Texas Occupations Code, Chapter 201, may be delegated to an
assistant who meets the training requirements set forth under §
78.1 of
this title (relating to Registration of Chiropractic Radiologic
Technologists).
(B) Technological
Instrumented Vestibular-Ocular-Nystagmus Testing may be performed by a licensee
with a diplomate in chiropractic neurology and that has successfully completed
150 hours of clinical and didactic training in the technical and professional
components of the procedures as part of coursework in vestibular rehabilitation
including the successful completion of a written and performance examination
for vestibular specialty or certification. The professional component of these
procedures may not be delegated to a technician and must be directly performed
by a qualified licensee.
(d) Analysis, Diagnosis, and Other Opinions.
(1) In the practice of chiropractic,
licensees may render an analysis, diagnosis, or other opinion regarding the
findings of examinations and evaluations. Such opinions could include, but are
not limited to, the following:
(A) An
analysis, diagnosis or other opinion regarding the biomechanical condition of
the spine or musculoskeletal system including, but not limited to, the
following:
(i) the health and integrity of
the structures of the system;
(ii)
the coordination, balance, efficiency, strength, conditioning and functional
health and integrity of the system;
(iii) the existence of structural pathology,
functional pathology or other abnormality of the system;
(iv) the nature, severity, complicating
factors and effects of said structural pathology, functional pathology, or
other abnormality of the system;
(v) the etiology of said structural
pathology, functional pathology or other abnormality of the system;
and
(vi) the effect of said
structural pathology, functional pathology or other abnormality of the system
on the health of an individual patient or population of patients;
(B) An analysis, diagnosis or
other opinion regarding a subluxation complex of the spine or musculoskeletal
system including, but not limited to, the following:
(i) the nature, severity, complicating
factors and effects of said subluxation complex;
(ii) the etiology of said subluxation
complex; and
(iii) the effect of
said subluxation complex on the health of an individual patient or population
of patients;
(C) An
opinion regarding the treatment procedures that are indicated in the
therapeutic care of a patient or condition;
(D) An opinion regarding the likelihood of
recovery of a patient or condition under an indicated course of
treatment;
(E) An opinion regarding
the risks associated with the treatment procedures that are indicated in the
therapeutic care of a patient or condition;
(F) An opinion regarding the risks associated
with not receiving the treatment procedures that are indicated in the
therapeutic care of a patient or condition;
(G) An opinion regarding the treatment
procedures that are contraindicated in the therapeutic care of a patient or
condition;
(H) An opinion that a
patient or condition is in need of care from a medical or other class of
provider;
(I) An opinion regarding
an individual's ability to perform normal job functions and activities of daily
living, and the assessment of any disability or impairment;
(J) An opinion regarding the biomechanical
risks to a patient, or patient population from various occupations, job duties
or functions, activities of daily living, sports or athletics, or from the
ergonomics of a given environment; and
(K) Other necessary or appropriate opinions
consistent with the practice of chiropractic.
(e) Treatment Procedures and Services.
(1) In the practice of chiropractic,
licensees recommend, perform or oversee the performance of the treatment
procedures that are indicated in the therapeutic care of a patient or patient
population in order to:
(A) Improve, correct,
or optimize the biomechanical condition of the spine or musculoskeletal system
of the human body including, but not limited to, the following:
(i) the health and integrity of the
structures of the musculoskeletal system; and
(ii) the coordination, balance, efficiency,
strength, conditioning, and functional health and integrity of the
musculoskeletal system;
(B) Promote the healing of, recovery from, or
prevent the development or deterioration of abnormalities of the biomechanical
condition of the spine or musculoskeletal system of the human body including,
but not limited to, the following:
(i) the
structural pathology, functional pathology, or other abnormality of the
musculoskeletal system;
(ii) the
effects and complicating factors of any structural pathology, functional
pathology, or other abnormality of the musculoskeletal system;
(iii) the etiology of any structural
pathology, functional pathology, or other abnormality of the musculoskeletal
system; and
(iv) the effect of any
structural pathology, functional pathology, or other abnormality of the
musculoskeletal system on the health of an individual patient or population of
patients; and
(C)
Promote the healing of, recovery from, or prevent the development or
deterioration of a subluxation complex of the spine or musculoskeletal system,
including, but not limited to, the following:
(i) the structural pathology, functional
pathology, or other abnormality of a subluxation complex;
(ii) the effects and complicating factors of
any structural pathology, functional pathology, or other abnormality of a
subluxation complex;
(iii) the
etiology of any structural pathology, functional pathology, or other
abnormality of a subluxation complex; and
(iv) the effect of any structural pathology,
functional pathology, or other abnormality of a subluxation complex on the
health of an individual patient or population of patients.
(2) In order to provide
therapeutic care for a patient or patient population, licensees are authorized
to use:
(A) osseous and soft tissue adjustment
and manipulative techniques;
(B)
physical and rehabilitative procedures and modalities;
(C) acupuncture and other reflex
techniques;
(D) exercise
therapy;
(E) patient
education;
(F) advice and
counsel;
(G) diet and weight
control;
(H)
immobilization;
(I)
splinting;
(J) bracing;
(K) therapeutic lasers (non-invasive,
nonincisive), with adequate training and the use of appropriate safety devices
and procedures for the patient, the licensee and all other persons present
during the use of the laser;
(L)
durable medical goods and devices;
(M) homeopathic and botanical medicines,
including vitamins, minerals; phytonutrients, antioxidants, enzymes,
nutraceuticals, and glandular extracts;
(N) non-prescription drugs;
(O) referral of patients to appropriate
health care providers; and
(P)
other treatment procedures and services consistent with the practice of
chiropractic.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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