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:
- Medical Decision Making
History is composed of...
- History of Present Illness
- et al...
So far, you and I do this every day, right?
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:
- Number of diagnoses or treatment options
- Amount and/or complexity of data reviewed
- Risk of complications and/or morbidity or mortality
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.
|Medical Decision Making||Moderately complex|
Additionally, 'face-to-face time' may be used to determine the level of service.
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?