The chiropractic profession tends to have its own vernacular. Maintenance care, wellness care, sick care, well care, preventive care, active care, supportive care, and the list goes on.

If you eavesdrop on a discussion between any four doctors of chiropractic, you will likely hear at least four different opinions on what each of these words mean. If you can’t recognize true maintenance care, then you’re at risk for violating the policy of certain third-party payers who have very distinct definitions of this care.

So what exactly is maintenance care, and how should it be documented in the office?

Maintenance or preventive care

Maintenance or preventive care is defined by Mercy as appropriate professionally acceptable treatment, usually for a chronic condition or after completion of therapeutic or supportive care, directed at a symptomatically stationary condition with anticipation of maintaining optimal body function, and usually provided on some routine or regular basis.

Continued treatment after a patient has reached maximum improvement, resolution, and/or stabilization of a condition would constitute maintenance-type care in nature.

This type of care is further defined by the Medicare program as:“Maintenance therapy includes services that seek to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.”

Supportive care

Supportive care is defined by Mercy as treatment/care for patients having reached maximum improvement, in which periodic trials of withdrawal from care fail to sustain previous therapeutic gains that would otherwise progressively deteriorate.

Supportive care follows appropriate application of active and passive care including lifestyle modification. It is appropriate when rehabilitative and/or functional restorative and alternative care options including home-based self care and lifestyle modifications have been considered and attempted.

Supportive care may be inappropriate when it interferes with other appropriate primary care, or when the risk of supportive care outweighs its benefits, such as physician dependence, somatization, illness behavior, and secondary gain.

What’s the difference?

Most doctors agree there are fundamental differences between maintenance care and supportive care. Maintenance care is typically rendered on a regular basis to help maintain optimal body function and usually when there is little or no active symptomatology or the symptoms have become dormant.

Supportive care is not typically rendered on a prescheduled or routine basis, but rather on an “as needed” basis solely in response to exacerbations.

Supportive care can be seen as “bursts of active care” rendered to return the patient to the previous stable status. It could range from one to many bursts of care per year, depending on activities of daily living, and other factors. These infrequent bursts of care may last from a few visits to several times a week for multiple weeks.

Maintenance care, on the other hand, is often prescheduled, where the patient is being seen monthly, biweekly, or other such frequencies.

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