eval codes Flashcards
red flags
signs of serious pathology
orange flags
could be psychiatric symptoms
yellow flags
beliefs appraisal and judgements; emotional responses, pain behavior
blue flags
perceptions about the rltp b/w work and health
black flags
system or contextual obstacles
what is an activity limitation
difficulties or restrictions of an individual executing a specific task
what is a participation restriction?
difficulties or restrictions on an individual in societal aspects of functioning or in life situations
ex. work, domestic life, school, community activities
Examining systems eqn
body systems examined + body areas examined
the ‘other’ system category
level of consciousness, cognition, learning preferences, expected emotional behavior or response
the body systems
musculoskeletal, neuromuscular, cardiovascular, integumentary
does taking vital signs fall under a certain system?
no, its not really something we examination.. its a screen
body areas
Head/neck, trunk, UE, LE
you will always look at 1 body area so anything more than that you add body area to the systems
When you give the final eval code you always give the highest complexity code. (T/F)
False, always give the lowest
What are the 4 names of the CPT codes
low complexity, moderate complexity, high complexity, re-evaluation
example of an unstable/unpredictable pt
amputee with non-healing wounds, history or frequent falls, unexplained dizziness with activity, decreased cognition, unpredictable behavior and unstable medical history
example of patient with evolving stability
musculoskeletal problem that has prolonged recovery, pregnancy, recent CVA with slow progression of return
who developed the CPT codes and has copyright
the AMA- American Medical Association
when were PT eval codes first used
1998
the new CPT codes were introduced in ___ of ___
January of 2017
has the CMS adopted the 3 tiered structure for payment?
no.. they currently only pay one rate for a PT evaluation
personal factors of the pt influence..
influence how the disability is experienced by the individual
ex. age, sex, social background, education, profession, past/current experience
environmental factors
physical, social and attitudinal environment in which they live
in order for personal factors and environmental factors to be considered they must ____
influence the plan of care
a stable clinical presentation
patient’s condition has not changed, remained constant, straight-forward, uncomplicated
Low complexity in history/limitations
no personal factors or comorbidities
Moderate complexity in history/limitations
1-2 personal factors of comorbidities
High complexity in history/limitations
3+ personal factors or comorbidities
Low complexity in examination (body parts and systems)
adresses 1-2 examination elements
Moderate complexity in examination (body parts and systems)
adresses 3 examination elements
High complexity in examination (body parts and systems)
Addresses 4 + examination elements
Low complexity clinical presentation
stable
Moderate complexity clinical presentation
evolving
High complexity clinical presentation
unstable/unpredictable
Examination aspect consists of
tests and measures
Your documentation is your
PROTECTION
the US healthcare system uses ___ for disease codes.
ICD-10
Typical Insurance
blue cross, cigna, humana, united healthcare
non-traditional
case, work comp, personal injury, auto (other person’s insurance)
Medicare Documentation guidelines
most comprehensive, typically adopted by other insurance carriers, APTA has worked with medicare to establish these guidelines for defensible documentation
functional G codes
added in 2014
must be completed/repeated on the 1st and 10th visit until discharge
was repealed when PT was accepted into MIPS program
MIPS/APMS and what its goal is
Merit Based Incentive Payment Program
Alternative Payment Model
Goal: collect data and pay for performance
ultimate goal of electronic medical records
one unified medical record
Threats to electronic medical records
data security, encryption, passwords, protection of protected health information
