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SJBird55 -> Re: Outpatient therapists identifying medical issues? (October 30, 2005 3:53:00 AM)
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I have the habit of monitoring vitals at the initial visit and then, in those patients that have multiple co-morbidities and have been recently hospitalized extra monitoring after activities. If after a couple of visits I don't see anything via the vitals that concerns me, I stop monitoring. So, from my practice patterns, I only really monitor after interventions when I've already identified a clinical reason to monitor. That means that I hardly ever monitor after interventions.
The probability of someone dying in the clinic secondary to masked hypertension is pretty low. The information may be valuable, yes - especially if I were the person with masked hypertension. I believe the biggest issue you are running up against in particular with Medicare rules and regulations is the simple fact that when you charge a 97110, reimbursement is only for the time the patient performs 97110. So, for the time the therapist is assessing vitals (which that time DOES add up), well, that therapist is not able to bill out for that procedure. In a way, we've been pigeon-holed into the CPT codes and have to spend more time watching the clock and the minutes versus just doing what needs to be done and getting paid for it. Which is sad, I know, but I'd believe that's probably some of the clinical rationale - time is money and if it isn't billable time then that is decreased profits. There isn't a CPT code for assessment of vitals. From questions I have asked, apparently "assessment time" falls into a gray area - which means that if what was billed out was ever audited, the person performing the audit is the one left to interpret whether what was billed out would have been considered fraud or not. I hate to say it, but I do believe that money plays a role in what we do or don't do, regardless of the benefit or perceived potential benefit for patients.
In those no-brainer situations, I generally put the patient on hold, contact the physician to report the response and then wait for the physician to determine the role of physical therapy.
Since I do have a decent relationship with most of the physicians I work with, I would be hestitant to report anything that wasn't obviously a problem OR communicate my findings with something that isn't standardized and valid to begin with.
It appears that with masked hypertension that the physicians may be getting office readings that are within normal ranges or maybe just slightly high... to tell a physician that "hey, there's a problem with this person's response to exercise" requires something for me to produce to substantiate my claim (I've been groomed by 3 particular physicians - I've learned that if I can back up my claim, especially with literature, there are no questions asked and whatever I advise is a done deal.... but, if I'm just shooting from the hip and using my gut intuition, well, they tend to give me the "wait and see" philosophy).
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