Tennessee § 63-4-101 - Practice of chiropractic — Education and clinical training — Scope of practice.

§ 63-4-101. Practice of chiropractic — Education and clinical training — Scope of practice.

As used in this chapter, unless the context otherwise requires: “Differential diagnosis” means the examination of body systems and structures of a patient to determine the source, nature, and extent of a disease or other physical condition for the purpose of establishing an appropriate plan of care for the patient, which may include referral to another provider for care that is outside the scope of practice of a chiropractic physician; “Diagnosis” means: The differential diagnosis of human ailments through examination and evaluation of patients and through diagnostic procedures necessary to clinically correlate a physical examination to a diagnostic impression; The ordering of X-rays, advanced diagnostic imaging, and other diagnostic procedures; The performance of X-rays and other non-invasive diagnostic procedures, as well as minimally invasive procedures for which the chiropractic physician has received training by an institution accredited by the Council on Chiropractic Education or its successor and which have been approved by the board of chiropractic examiners after consultation with the board of medical examiners; and The collection of blood, urine, saliva, and hair for analysis; provided, however, venipuncture shall only be done by a phlebotomist or other person who is properly trained to draw blood; “Practice of chiropractic” means the diagnosis and treatment of patients, as defined in subdivisions (a)(1)(B) and (D); and “Treatment” means: The treatment of neuromuscular, musculoskeletal, and related conditions through the use of chiropractic adjustment and manipulation; physical agent modalities; manual, rehabilitative, and other therapeutic care; and mechanical, chemical, electrical, and thermal methods; The use of acupuncture by a chiropractic physician who has completed two hundred fifty (250) hours of an accredited acupuncture course and has passed the National Board of Chiropractic Examiners Acupuncture Exam; The location and removal of interference with nerve transmission and nerve function; The making of appropriate referrals to other healthcare professionals for conditions that are outside the scope of practice of a chiropractic physician; The ordering of durable medical equipment for patients who need such equipment to assist in the restoration of their health under the plan of care for treatment of their neuromuscular, musculoskeletal, and related conditions; and The provision of supportive care with due regard for nutrition, hygiene, sanitation, and rehabilitation designed to assist in the restoration and maintenance of a patient's health. Nothing in this chapter authorizes a chiropractic physician to engage in the practice of medicine and surgery or osteopathy, as defined in chapters 6 and 9 of this title, or to prescribe legend drugs or controlled substances. As used in this chapter, “chiropractic physician” means a person who is a graduate of a chiropractic college accredited by the Council on Chiropractic Education or its successor, or is a graduate of an international chiropractic college approved by the board of chiropractic examiners, and who has received a license issued by the board of chiropractic examiners. No person licensed under this title may perform a spinal manipulation or spinal adjustment without first having the legal authority to differentially diagnose and having received a minimum of four hundred (400) hours of classroom instruction in spinal manipulation or spinal adjustment and a minimum of eight hundred (800) hours of supervised clinical training at a facility where spinal manipulation or spinal adjustment is a primary method of treatment. “Spinal manipulation” and “spinal adjustment” are interchangeable terms that identify a method of skillful and beneficial treatment where a person uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity. A violation of this section is an unlawful practice of chiropractic and is grounds for the offending health care provider's licensing board to suspend, revoke or refuse to renew such provider's license or take other disciplinary action allowed by law. Nothing in this subsection (c) shall in any way apply to the scope of practice of: An osteopathic physician licensed under chapter 9 of this title; or Any person who practices medicine or surgery who is licensed under chapter 6 of this title. Acts 1923, ch. 9, § 5; Shan. Supp., § 3654a120; Code 1932, § 7013; Acts 1941, ch. 29, § 2; C. Supp. 1950, § 7013; Acts 1980, ch. 673, § 1; T.C.A. (orig. ed.), § 63-401; Acts 1999, ch. 323, § 1; 2003, ch. 166, § 1; 2006, ch. 775, § 1; 2017, ch. 455, §§ 1, 2. Amendments. The 2017 amendment rewrote (a) and (b) which read: “(a) The term ‘chiropractic’ where used in this chapter is defined as the science and art of locating and removing interference with nerve transmission and nerve function. A chiropractic physician diagnoses and treats neuromuscular and musculoskeletal conditions through physical agent modalities and manipulative therapies. The adjustment, manipulation or treatment shall be directed toward restoring and maintaining the normal neuromuscular and musculoskeletal function and health of the patient. A chiropractic physician will also make appropriate health referrals for conditions that may not be treated by physical agent modalities and manipulative therapies. Patient care shall be conducted with due regard for nutrition, environment, hygiene, sanitation and rehabilitation designed to assist in the restoration and maintenance of the patient's health. Nothing in this chapter shall be construed to authorize the chiropractic physician to practice any branch of medicine osteopathy, as defined in chapters 6 and 9 of this title, or surgery, including venipuncture or the prescribing of medication, acupuncture being the exception. “(b) As used in this chapter, ‘chiropractic physician’ means a graduate of an accredited chiropractic college authorized to confer upon graduates the degree of doctor of chiropractic (D.C.), who is duly licensed in this state.” Effective Dates. Acts 2017, ch. 455, § 8. July 1, 2017. Cross-References. Assignment of insurance benefits to health care provider, § 56-7-120 . Duties of chiropractors regarding known or suspected child sexual abuse, §§ 37-1-403 , 37-1-605 . Liability of professional societies, title 62, ch. 50, part 1. Occupation tax on chiropractors, title 67, ch. 4, part 17. Reimbursable services within scope of practice of chiropractor, discrimination prohibited, § 56-7-2404 . Textbooks. Tennessee Jurisprudence, 20 Tenn. Juris., Physicians and Surgeons, § 6. Law Reviews. Report on Administrative Law to the Tennessee Law Revision Commission, 20 Vand. L. Rev. 777. Attorney General Opinions. Doctors of chiropractic may not order and receive the results of diagnostic testing from licensed medical laboratories, including urinalysis, arthritis panel, urine count, glucose tolerance test, male-female endocrine profile, standard blood profile (CBC with differential), and pregnancy testing, OAG 00-131, 200 Tenn. AG LEXIS 132 (8/15/00). Chiropractors may not practice a treatment modality that involves the insertion of needles with the intent bring about the same result as the needle insertion techniques applied in the practice of acupuncture, without first obtaining a certification to practice acupuncture, OAG 05-020, 2005 Tenn. AG LEXIS 20 (3/08/05). A licensed physical therapist may not perform or hold himself or herself out as performing “spinal manipulation,” as that term is used in former T.C.A. § 63-4-101(c)(1) (now T.C.A. § 63-4-101(b)(1) ), without first having fulfilled the requirements of that section, OAG 07-055 (4/23/07).