"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

Wednesday, March 11, 2009

Do you make doctor-level decisions?

One of the missions of this blog is to help physical therapists make better decisions diagnosing and treating your patients.

Physical therapists aim to be doctor-level decision makers but what are the differences in how physicians and physical therapists decide?

Are there similarities, too?

What are they?

This chart shows the process physicians use to decide which Evaluation and Management (E/M) code to bill.

There are three components to the physician encounter used in decision-making:
  1. History
  2. Examination
  3. Medical Decision Making
Note that physical therapists use this same process in the initial evaluation.

History is composed of...
  1. History of Present Illness
    • location
    • severity
    • timing
    • et al...
  2. Review of Systems
    • constitutional
    • musculoskeletal
    • neurological
  3. Past Medical, Family and Social History
Same old, same old

So far, you and I do this every day, right?

The Examination

The examination focuses on Body Areas and Organ Systems - the more the physician examines the higher she can code.

Physical therapists usually examine back (spine), extremities, neck, maybe the abdominal body areas.

We examine 'cardio', 'musculo', skin, 'neuro', 'resp' and constitutional organ systems.

Physicians examine more areas and systems than do physical therapists and can perform 'detailed' or 'comprehensive' examinations in this part of the process.

Medical Decision Making

Three 'grids'are presented:
  1. Number of diagnoses or treatment options
  2. Amount and/or complexity of data reviewed
  3. Risk of complications and/or morbidity or mortality
Physical therapists consider many treatment options and possible diagnoses but our limited ability to order sensitive testing and further diagnostic procedures hampers our scores on these grids - in my opinion.

Show Time

I used a 'typical' physical therapy LBP patient and went through the process - answering the questions physicians have to answer for each new (or established) patient.

ExaminationExpanded, problem-focused
Medical Decision MakingModerately complex

Additionally, 'face-to-face time' may be used to determine the level of service.

One-on-one anyone?

Take Home Message

Many physical therapy lumbar evaluations may qualify for a Level 3 or 4 E/M code, if physical therapists were allowed to bill like physicians.

Take a look for yourself - do you make doctor-level decisions?

Free Tutorial

Get free stuff at BulletproofPT.com

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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