Diagnostic and Adjunctive Procedures

PURPOSE: This rule outlines diagnostic and adjunctive procedures that may be used by chiropractic physicians. (1) The board approves the use of those diagnostic procedures and instruments which are commonly taught by approved chiropractic colleges. (2) Diagnostic procedures approved by the board include, but are not limited to, the following— (A) Physical Examination: 1. Inspection, including the use of instrumentation such as an ophthalmoscope, otoscope, tongue-depressor, tape mea sure, thermometer, percussion hammer, pinwheel, sphyg momanometer, proctoscope, nervoscope, neurocalometer, neurodermagraph, electromyograph, heartometer, phonocar diograph, electrocardiograph, spirometer, vitalor, visual acu ity charts, weight measurement scales, dermathermagraph, vasculizer, and routine orthopedic and neurologic procedures; 2. Palpation; or 3. Auscultation, including the use of a stethoscope, tuning forks, audiograph, and phonocardiograph. (B) Diagnostic imaging: 1. Motionless diagnostic X-ray study; 2. Fluoroscopy; 3. Cineradiography; 4. Magnetic Resonance Imaging (MRI); 5. Computerized Tomography (CT SCAN); 6. Ultrasound; or 7. Magnetic Resonance Angiogram (MRA). (C) Clinical laboratory tests: 1. Blood specimen; 2. Urine specimen; 3. Fecal specimen; 4. Sputum specimen; 5. Hair specimen; or 6. Mucosal specimen. (D) Muscle testing with strength and endurance curves during isometric or isokinetic exercise. (3) Those adjunctive chiropractic procedures presently ap proved by the board include, but are not limited to: (A) Heat and heat-producing devices; (B) Ice and cooling packs; (C) Extension therapy; or (D) Therapeutic exercise, muscle therapy, reflex techniques, and postural and structural supports. (4) In order to avoid overutilization of ionizing radiation, a chiropractic physician shall observe the following guidelines: (A) Routine radiography of any patient shall not be performed without due regard for clinical need; and (B) Repeat radiographic evaluation of the patient shall not be undertaken without clinical indication, as determined by the treating chiropractic physician. (5) The licensee shall comply with all applicable state and fed eral requirements concerning any registration or maintenance of X-ray equipment. AUTHORITY: section 331.010, RSMo 2016.* This rule originally filed as 4 CSR 70-2.030. This version of rule filed Dec. 17, 1975, effective Dec. 27, 1975. Amended: Filed July 5, 1978, effective Oct. 13, 1978. Rescinded and readopted: Filed July 9, 1982, effective Nov. 11, 1982. Amended: Filed July 31, 2003, effective Jan. 30, 2004. Moved to 20 CSR 2070-2.030, effective Aug. 28, 2006. Amended: Filed March 29, 2019, effective Oct. 30, 2019. *Original authority: 331.010, RSMo 1939, amended 1969, 1982, 1995, 2007. 20 CSR 2070-2.031 Meridian Therapy/Acupressure/ Acupuncture PURPOSE: This rule sets out the acceptable qualifications, procedures, and continuing education requirements for the use of meridian therapy/acupressure/acupuncture (in this rule Meridian Therapy) by Missouri licensed chiropractors. (1) For the purpose of the rules meridian therapy includes meridian therapy, acupressure, and acupuncture as set forth in section 331.030.8, RSMo. (2) An applicant for certification in meridian therapy shall submit the following to the board: (A) An application for certification accompanied by the required fee, pursuant to 20 CSR 2070-2.090(1); (B) An official transcript or certificate of completion documenting a minimum of one hundred (100) hours of credit of undergraduate or postgraduate study or a combination of each in the use and administration of meridian therapy. The hours of education in meridian therapy shall be approved by the board or from a chiropractic college accredited by the Commission on Accreditation of the Council of Chiropractic Education. For the purpose of this rule, the one hundred (100) hours of study in meridian therapy shall not be offered electronically to include via the internet, webinars, or similar delivery methods and shall not include dry needling; and (C) Official examination results documenting passing one (1) of the following examinations: AND INSURANCE 1. National Board of Chiropractic Examiners (NBCE); 2. American Board of Chiropractic Acupuncture (ABCA); or 3. National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). (3) The board adopts the passing score established by NBCE, ACBA, or NCCAOM as the passing score for Missouri applicants. (4) An applicant for certification in meridian therapy shall comply with the examination provider’s rules for test administration related to applicant conduct and shall authorize the examination provider to submit the results to the board, along with any information relating to any adverse incident(s) involving the applicant during the course of the examination. Any cost associated with reporting examination results to the board shall be the applicant’s responsibility. (5) Any licensee certified in meridian therapy shall follow universal precautions as defined by the United States Department of Labor’s Occupational Safety and Health Administration (“OSHA”) (Bloodborne Pathogens Standard 29 CFR 1910. 1.030(B) relating to infection control with respect to certain human body fluids as if they were known to be infections for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), or other blood borne pathogens, and the most current version of the Clean Needle Technique (CNT) manual as published by the Council of Colleges of Acupuncture and Oriental Medicine©. (6) A licensee certified in meridian therapy shall use only disposable acupuncture needles and shall dispose of such needles in compliance with established standards for biohazardous waste. (7) The acupuncture certification shall be renewed at the time of licensure renewal. The licensee shall obtain twelve (12) hours of board approved continuing education in meridian therapy prior to the expiration date of the license. The twelve (12) hours of continuing education in meridian therapy shall apply to the twenty-four (24) hours of formal continuing education required to maintain the chiropractic license and shall not include dry needling. (8) An expired certification in meridian therapy can be reinstated up to five (5) years from the expiration date by submitting an application and required fee pursuant to 20 CSR 2070-2.090(1) along with proof of completing twelve (12) hours of board approved continuing education in meridian therapy which shall be completed prior to submitting the reinstatement application. (9) A certification in meridian therapy expired for more than five (5) years from the expiration date of the certification can be reinstated by submitting an application for certification, required fee pursuant to 20 CSR 2070-2.090(1), and documenting completion of a minimum of one hundred (100) hours of credit of postgraduate study in the use and administration of meridian therapy. The hours of education in meridian therapy shall be either hours which are approved by the board or hours which are obtained from a chiropractic college accredited by the Commission on Accreditation of the Council of Chiropractic Education. Hours for reinstatement of the certification in meridian therapy cannot be the same one hundred (100) hours used for original certification. AUTHORITY: sections 331.010, 331.050.1, and 331.100.2, RSMo 2016, and sections 331.030.5 and .8, RSMo Supp. 2018.* This rule originally filed as 4 CSR 70-2.031. Original rule filed Jan. 5, 1987, effective April 11, 1987. Amended: Filed March 4, 1994, effective Aug. 8, 1994. Amended: Filed April 14, 2000, effective Oct. 30, 2000. Amended: Filed April 1, 2004, effective Sept. 30, 2004. Moved to 20 CSR 2070-2.031, effective Aug. 28, 2006. Amended: Filed Aug. 15, 2008, effective Feb. 28, 2009. Amended: Filed Aug. 27, 2009, effective Feb. 28, 2010. Rescinded and readopted: Filed March 29, 2019, effective Oct. 30, 2019. *Original authority: 331.010, RSMo 1939, amended 1969, 1982, 1995, 2004, 2007; 331.030, RSMo 1939, amended 1945, 1947, 1949, 1969, 1981, 1988, 1993, 1995, 1997, 2007, 2018; 331.050, RSMo 1939, amended 1945, 1947, 1969, 1981, 1987, 1999, 2001, 2004; and 331.100.2, RSMo 1939, amended 1949, 1969, 1980, 1981, 2008, 2013.