"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, January 4, 2009

Physical therapists: Put your diagnosis in your goal

This extra step in your clinical thought process can dramatically improve your notes and charts for your Medicare compliance program.

The simple act of linking the measured impairment to the patients' activity limitation is one of the essential skilled components of physical therapist practice.

For example:
“Improve sidelying hip external rotation from 15cm to 25cm in order to improve OPTIMAL Balance from 4/5 to 2/5.”
Your clinical rationale is explicit in the goal – without the need for additional statements clarifying the link between measured impairments (hip external rotation) and patient activity limitations (balance).

Your physical therapy diagnosis may change from body part to body part and from activity to activity.

For example, the same patient may have the following goal:

“Improve AROM ankle dorsiflexion from 0 degrees to 10 degrees in order to improve OPTIMAL Stairclimbing from 4/5 to 2/5.”

Diagnosis differences

The interesting thing is that our diagnosis is not predicated on any medical model.

In the examples above, the written reason for patient referral was the following:

‘lumbar strain’ – ICD-9 code 722.93 (Other and unspecified disc disorder, lumbar region).

The physical therapist independently identified the two above mentioned areas above that needed attention that could not be consistently predicted by the medical diagnosis.

The ICF model, on the other hand, more accurately identifies the work and the decisions made by the physical therapist.

A physical therapist might diagnose, using these ICF codes, the activity limitations and impairments in body structure and function.

ICF DomainICF descriptorICF code
ActivityWalking on different surfacesd4502
Body structureMuscles of ankle and foots75022
Body functionMobility of a single jointb7100

Using a disablement model as the decision-making framework and making the commitment to always diagnose every patient the physical therapist is freed from the subservient, technical position in the medical model.

The physical therapist is put in the position of making decisions that are in the best interests of the patient, based on the finding from the physical therapy evaluation.

No other professionals are examining patients at this level:

  • not physicians
  • not chiropractors
  • not massage therapists
  • not athletic trainers.

Decision-making and the physical therapists’ diagnosis are the sustainable competitive advantage of physical therapy over all of these other professions in the care and rehabilitation of our patients.

Put your diagnosis in your goals to improve your written work.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.