"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

Tuesday, February 10, 2009

Physical Therapists and Physicians have something in common

Physical therapists and anesthesiologists have something in common.

Both professions have difficulty showing need for their services.

  1. Exercise by physical therapists.

  2. Facet joint injections by anesthesiologists and other physicians.

This report by the Office of the Inspector Generals' (OIG) indicates physicians have difficulty showing medical necessity for spinal facet joint injections.

Eight percent of the claims were paid despite no evidence (x-ray fluoroscopy) that the services were medically necessary. The overall paid claims error rate for facet joint injections was 63%.

Physicians use fluoroscopic imaging to demonstrate pathology necessary for medical diagnosis and treatment by facet joint injection.

However, the...
"...lack of consensus in the medical community about appropriate frequency of injections is a barrier to creating frequency limits in Local Coverage Determinations."
Thirteen of the 15 Medicare Carriers have Local Coverage Determinations that set forth medical necessity requirements for facet joint injections.
"Carriers are also responsible for implementing program safeguards to reduce payment errors. To accomplish this, carriers create local coverage determinations (LCD), issue instructional articles implement claims processing edits. Carriers also analyze data, conduct provider education, and conduct medical reviews."
An uncertain environment

Physical therapy medical necessity is even more ambiguous - for instance, there are no National or Local Coverage Determinations (LCD) that determine the criteria for physical therapy services like the following"
  • Therapeutic Exercise (97110)
  • Manual Therapy (97140)
  • Neuromuscular Reeducation (97112)
Currently, the standard for physical therapy medical necessity is the 'expert opinion' of a Medicare auditor (who may or may not be a physical therapist).

The 'expert' reviews your written notes to see if the exercise codes you billed Medicare are necessary.
"It is encouraged but not required that narratives that specifically justify the medical necessity of services be included in order to support approval when those services are reviewed." (Transmittal 88)
Can't physical therapy reporting get more transparent, less hazardous or both?

Why, when our focus is patient treatment, should we be forced to spend valuable patient time on lengthy notes and charts?

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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.
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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.