Midterm Medicare and Posture Analysis Flashcards
What are the three components required in order to establish medical necessity for medicare to cover manual manipulation of the spine to correct a subluxation?
presence of a subluxation that causes a significant neuromusculoskeletal condition, documentation of the subluxation, and documentation of the initial and subsequent visits
If a subluxation is documented by physical examination what 4 component system must be used (for medicare)?
PART system
What are the meanings behind the letters of the PART acronym?
P - pain and tenderness, A - asymmetry/misalignment, R - range of motion abnormality, and T - Tissue, tone changes
Other than relevant history of patient’s condition, evaluation by physical exam, and diagnosis, what documentation is required at a patient’s initial visit?
treatment plan and date of initial treatment
What documentation is required at subsequent visits?
History, physical examination, treatment given, and any changes to treatment plan (PHAT)
What is included in documenting a patient’s history?
review of chief complaint, improvement/regression since last visit, and a system review if relevant
When using the PART system, what are the 5 different methods to assess P?
observation, percussion/palpation/provocation, visual analog type scale, audio confirmation and/or pain questionnaires
When using the PART system, what are the 3 methods to assess A?
observation, static/dynamic palpation, and/or diagnostic imaging
When using the PART system, what are the 4 methods to assess R?
observation, motion palpation, stress diagnostic imaging, and/or range of motion measuring devices
When using the PART system, what are the 4 methods to assess T?
observation, palpation, use of instrumentation, and/or tests for lengths/strength
When documenting the patient’s pain during examination using observation as the method to document P, what 3 aspects of pain should be documented?
location, quality, and severity
When documenting pain and tenderness, you ask the patient “let me know if any of this causes discomfort.” What method of assessing “P” are you using?
Percussion/palpation/provocation
When you observe a patient’s posture or gait, what component of the PART system are you assessing?
A (asymmetry/misalignment) via observation
What 3 methods of imaging are accepted for assessing the A or PART?
x-ray, CAT scan, and MRI
If you take x-rays of the patient using bending views, what method are you using to assess R of PART?
stress diagnostic imaging
What are goniometers and inclinometers used for?
measuring range of motion
What visible changes could be documented when assessing T of PART?
signs of spasm, inflammation, swelling, rigidity, etc
When documenting leg length, scoliosis contracture, and strength of muscles that relate, what component of PART is being assessed?
T (tissue, tone changes) via Tests for length and strength
T/F: adjustments for maintenance are covered by Medicare.
False; only therapeutic adjustments are covered
When performing a postural analysis, what 3 things should be assessed while in an Anterior view?
Global List, Head Tilt, and Thoracic Tilt
What landmarks should be used when assessing Global Tilt from an anterior view?
Sternum-baseline
What landmarks should be used when assessing head tilt from an anterior view?
glabella-nose-chin
What landmarks should be used when assessing a thoracic tilt from an anterior view?
AC joints
What two assessments of a postural analysis can never be described as neutral but rather NAD/WNL?
Thoracic kyphosis and lumbar lordosis
What does NAD/WNL mean?
no abnormalities detected/within normal limits
What 5 things should be assessed from a lateral view during a posture analysis?
global list, head carriage, thoracic kyphosis, thoracic rotation, and lumbar lordosis
What are the landmarks for Global list from a lateral view?
AC-baseline
Landmarks for head carriage from a lateral view?
EAM-AC
Landmarks for thoracic rotation during lateral view?
back-chest prominence
What 6 assessments should be made from a posterior view during a postural analysis?
Head rotation, head translation, scoliosis, scapulae, pelvic tilt, and pelvic rotation (HH SS PP)
Landmarks for head rotation from posterior view?
facial prominence
landmarks for head translation during posterior view?
EOP-VP
landmarks for scoliosis?
spinous processes
landmark for pelvic tilt?
crests/psis’s
landmarks for pelvic rotation?
gluteal prominence
