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documenting PROM?
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documenting PROM? - November 3, 2007 5:49:59 PM
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pta4u
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Joined: May 29, 2003
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Hi. I am a PTA working in a small outpatient clinc associated with our local hospital. My rehab manager (a PT) recently pulled me aside and told me that I am not to write that I am doing PROM in my documentation or on the flow under theraputic exercise. Now this particular patient that she happened to be reviewing was a fresh rotator cuff repair with specific orders from MD for...PROM only. I told her that that is what the MD ordered and that is what I did so that is why I documented PROM. She was very upset and told me that we cannot bill for the PROM (pt. is Medicare) so I will have to document it differently, basically told be to write that it was AAROM. I told her I would not change it because then I would be going against the orders of the MD. ???? I believe she is mistaken about this...however she seems to be quite adament about it (said PROM is considered maintenence so can't bill for it). Anyone with any insight into this would be greatly appreciated. (** I have worked in this clinic for 4 years..3 under this rehab manager and have always documented this way without ever a word from anyone)
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RE: documenting PROM? - November 3, 2007 6:46:33 PM
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SJBird55
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From: Michigan
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You're fine. The claim you are submitting should have therapeutic exercise as the code. Document what planes of motion, amount of guarding, endfeel, amount of motion then what you are providing is skilled intervention. If it makes her feel better, document PROM per physician protocol - active activity contraindicated at this time. Your patient will not be at PROM forever and will be progressing to AAROM and your documentation will reflect that as she heals from surgery.
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RE: documenting PROM? - November 3, 2007 9:19:52 PM
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blast7
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You should be fine unless you are performing PROM throughout her full normal range and she has no restrictions. On the flip side I do believe that patients with CP are able to get PROM billed d/t the risk of joint contractures d/t spasticity and immobility.
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RE: documenting PROM? - November 3, 2007 9:59:46 PM
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jma
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From: NY
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Yes, document PROM with AROM contraindicated by MDs order on the script.
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RE: documenting PROM? - November 5, 2007 7:51:33 AM
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buckeye
Posts: 181
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Documenting PROM as noted above is fine. SJBird55 is correct in the therapeutic exercise being the billed modality and this will be short-term use. You need to document why the PROM requires the skilled care with physical therapy (cormorbid conditions, protection of repair, unable to perform safely at home, etc.)
If a caregiver is able to perform PROM on the days not attending PT, then regular PT visits in the first few weeks after surgery (while only PROM) may not be necessary.
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RE: documenting PROM? - November 5, 2007 9:20:36 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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with medicare it is tricky, I agree. Your plan needs to reflect your goals. If your only plan is PROM and you have no functional goals to match this, it would be tough to get that paid for from medicare if it was audited. You may have to teach the caregiver PROM, or teach the patient self PROM and let them go off on their own, or better yet stay in home health while it is PROM. Easier to document and get paid for that in home health. But to just do PROM on a shoulder, while it does seem very basic for a PT to be doing, is not going to be paid so easily by medicare if audited. So if you said my goal was to increase rom of shoulder flexion to greater than 90 degrees to allow patient to independently dress UE, and my plan was to do PROM and then progress to AAROM and AROM and PRE as tolerated and medically appropriate when prescribed by MD, then you may be able to get away with it, but basically, be VERY careful with documentation, and re-think this if it is truly necessary to do this with this medicare patient, or can they be doing this with pulley or cane supine? Just some food for thought...
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RE: documenting PROM? - November 5, 2007 10:21:44 PM
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PTupdate.com
Posts: 1490
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From: Pittsburgh, PA USA
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I'd take what Ben says and add an extra thought. How about billing 97530? We are doing this PROM in order to achieve functional use of the shoulder, and really none of the motions are "pure", but rather combined motions designed to achieve a functional goal.....reaching overhead to dress, groom and take things out of closets....reach behind back to tuck in shirt and hook bra.....reach out and back to put on a coat, etc.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: documenting PROM? - November 6, 2007 12:44:56 PM
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pta4u
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I thank you all for your feedback. This is still an ongoing discussion at our clinic (unfortunately). Our rehab managed is going to address this at our next meeting, but having discussed this with the other PT's and PTA's on my own, I find that they always document PROM if ordered by MD. Soooo we shall see what becomes of this :) However, while reading through your informative responses I read to teach pt's possibly with pulleys or wand/cane ROM. Correct me if I'm wrong but are these not AAROM?
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RE: documenting PROM? - November 6, 2007 1:11:58 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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Don't treat the patient inappropriately just because of billing. Give them what they need and deserve, and in this case it's PROM.
Under certain circumstances, with the right patient, they can be taught self PROM using the other hand while supine, a cane (for flexion and/or ER), and even the pulleys. You have to learn which ones you can trust, and which ones you can't. Some people with RCR are just so relaxed and passive, that one can trust them to perform their own PROM and have it actually be passive. Others are either too tense, protect too much, and sometimes just too pushy, and probably will end up contracting the repaired tissue more than it needs.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: documenting PROM? - November 6, 2007 2:24:04 PM
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FLAOrthoPT
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From: West Palm Beach
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ditto
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RE: documenting PROM? - November 7, 2007 4:11:54 PM
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buckeye
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Exclellent points from PT Update and FLA Ortho. We need to give the patient the skilled therapy care that is needed for the point in time after surgery. The patient, surgeon, and staff must realize that getting reimbursed by Medicare does not happen just because it is ordered by a physician.
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