I answered a question today on the Yahoo Groups PT Manager list-serve.
Hello Group,
I am looking for any information or suggestions on Treatment Diagnoses vs. Medical Diagnoses. I am having difficulty finding many good treatment diagnoses for my patients who do not have obvious gait abnormalities or radicular weakness secondary to their conditions.
Because our population is mostly spine we tend to end up with more medically based diagnoses such as disc herniation or sciatica.
I would appreciate any feedback or suggestions on this.
New Grad
******************
Dear New Grad,
We also treat a lot (~50%) spine and we get lots of anatomic (medical)
diagnoses (eg: SI strain, HNP, sciatica).
A few years ago we started mandating a physical therapists' diagnosis
for every patient.
Now, we are able to do the following:
- improve treatment selection
- improve goal-setting
- demonstrate medical necessity
- show progress
- show skilled decision-making
...using a baseline activity scale (OPTIMAL) and a disablement model
(ICF).
We started studying these issues for our Medicare compliance program
and then we noticed patients were getting better quicker.
We use a problem list, not a diagnostic label.
I'll use 'shoulder bursitis' as an example.
We would diagnose "Difficulty Lifting & Carrying due to the following:
- weak shoulder external rotator muscle
- weak shoulder flexor muscle
- stiff shoulder flexion ROM
- stiff trunk sidebending ROM
...to be treated with the following...
- Ther Ex (97110) to strengthen shoulder flexors and external rotator
muscles.
- Manual Therapy (97140) to improve ROM of shoulder flexion and trunk
SB.
- Neuro Re-ed (97112) to distinguish shoulder rotation from trunk
rotation.
- Ther Acts (97530) for Lifting without scapular elevation.
Goals:
1) Improve shldr. ER from X to Y to improve Lifting from 4/5 to 3/5.
2) Improve shldr. flexion from X to Y to improve Lifting.
3) Improve trunk SB from X to Y to improve Carrying from 4/5 to 3/5."
(Note: OPTIMAL estimated MCID = 1.0)
In my state (Florida) my carrier (FCSO) does not use
diagnostic 'crosswalks' and I've not had denials based on using the
physician's diagnosis.
We'll have ICD-10 before physical therapists get to bill using the
ICF code set so I'm not even sure the diagnosis on the claim form
matters.
Physicians appreciate the problem list because they don't check this
stuff - no one else does either.
Linking Activity Limitations to Impairments is the physical
therapists' diagnosis.
Physical therapy diagnosis is a sustainable competitive advantage in
the health care market.
Tim
Home »
icf model »
OPTIMAL scale »
physical therapy clinical decision making »
physical therapy diagnosis »
Rabu, 14 Januari 2009
Artikel Terkait :
Is the OPTIMAL a subjective scale?"It's a hurt but not a pain.""My pain hurts when I stand at the counter to fix meals longer than five minutes.""It gnaws and hurt ...
Value Centered Physical TherapyThis post comes from a thread in the Yahoo Groups PT Manager listserve between Rick Gawenda, APTA Adminstration Section President ...
Cut Medicare to Increase Physical Therapy Value Proposition?American Physical Therapy Association applauds Senator Max Baucus for standing up against efforts to abolish the Automatic Except ...
Medicare Fraud Strike Force Indicts Eight in MiamiSo far this and other Medicare actions in the South Florida area do not appear to have involved physical therapists.The Medicare ...
Physical therapists: Put your diagnosis in your goalThis extra step in your clinical thought process can dramatically improve your notes and charts for your Medicare compliance prog ...
Langganan:
Posting Komentar (Atom)
0 komentar:
Posting Komentar