Therapies
What is the difference between Direct Supervision and Indirect Supervision?
*Bonus: Can we Group TEs and TAs?
Direct Supervision (TE, TA, Neuro) - clinical staff should be present and actively supervising the patient throughout the duration of the exercise to provide hands-on support ensuring exercises are performed correctly through guidance on proper form, breathing, or adjustments to prevent injury.
Indirect Supervision (GT, Traction) - indirect supervision could be permissible if the patient has already been trained, the exercise is safe to perform independently, and the clinical staff is monitoring the patient from a distance, ensuring safety by periodically checking in.
*Bonus: Yes, TEs and TAs can be categorized as Group Therapies when the patient performs them with Indirect Supervision from the clinical staff.
What common visit types are scheduled under the office provider chiropractic column?
Final Evaluation
Follow up
Imaging Review
Progress Evaluation
Xray
What are lidocaine patches and their benefit?
Demonstrate dispensing lido to a patient.
Lidocaine patches are medicine patches that provide temporary pain relief of the joints and muscles.
*Demo*
What about Statefarm patients?
What is the documentation protocol we follow when an exercise is prescribed as TE/TA but is performed as a Group Therapy?
*Hint: 2 Steps *
When a TE/TA exercise is performed as Group Therapy, that therapy must be legibly hand-written under the Group Therapy section of the travel card. Simply writing 'GT' next to the therapy or drawing an arrow down to the Group Therapy section does not suffice.
When a TE/TA exercise is performed as Group Therapy, we will now document this within the eCW Progress Note as well. A template named 'ICR Group Therapy Statement' has been created to quicky accomplish this.
What are the 5 major sections of the spine? How many vertebrae in each section?
Cervical - 7 vertebrae (atlas & axis)
Thoracic - 12 vertebrae (connects to ribcage)
Lumbar - 5 vertebrae (largest vertebrae)
Sacrum - 5 fused vertebrae (connects spine to hip bones)
Coccyx - 3-5 small, fused vertebrae (provides attachment for ligaments and muscles of the pelvic floor)
What are the benefits of traction?
Promotes posture (cervical and lumbar curve)
Reduces pressure on discs and nerves
Rehydrates discs
Lightly stretches the musculature promoting blood flow into the region
When should New Patients sign IOT
After NP exam
What is an LSO and what are its benefits?
Demonstrate dispensing an LSO to a patient.
Lumbosacral Orthosis (LSO) brace is a back brace that provides pain relief by stabilizing and supporting the spine when performing pain producing activities.
*Demo*
When is it appropriate to add the -59 modifier to TE (97110) and TA (97530)?
You should add a -59 modifier to TE (97110) and TA (97530) when GT (97150) is billed in the same visit.
What is our high blood pressure protocol and when should it take effect?
*Demonstrate how to take manual BP*
If initial blood pressure is high (140/90):
Alert the DC (including Floater DCs)
Let patient rest
Retake manually
Update the DC on new BP and ask for next steps
Document all BPs on the TC and Daily Note
What is the purpose of neurorehabilitation therapies?
Neurorehab aids in the recovery and improvement of motor, cognitive and sensory functions in patients who have suffered a neurological injury (concussion).
It helps strengthen the weaker parts of the brain that were injured in the accident.
What must be collected and scanned in at a new patient’s appointment?
Photo identification
Auto insurance
Medical Insurance
What is a CTC and what are its benefits?
Demonstrate dispensing a CTC to a patient.
A Cervical Therapy Collar (CTC) is a therapy collar that promotes posture, relieves pressure on the muscles, nerves and discs in the cervical spine, and can help reduce inflammation if used with the ice pack.
*Demo*
When is it appropriate to add the -59 modifier to NMR (97112)?
You should add a -59 modifier to NMR (97112) when GT (97150) and/or CMT (98940, 98941, and/or 98942) is billed in the same visit.
What is the difference between TE (97110) and TA (97530)?
TE - used to develop strength, endurance, range of motion and flexibility.
TEs address basic strength and mobility deficits to help build the foundation for strength and mobility in patients recovering from an injury or surgery.
TA - used to improve patients’ ability to perform functional activities.
These activities focus on improving functional mobility and performance of daily tasks by simulating real-world tasks or movements related to the patients’ daily life or work activities helping them reintegrate into daily or work-related activities after an injury or surgery.
What are the benefits of stretching exercises and what is the proper stretching technique?
Increases ROM, flexibility, blood flow to the muscles, muscle control and improves posture.
Decreases muscle spasms.
Proper technique: warm up, keep breathing, don't bounce, pain free.
What two appointment types can a patient have an EMC form completed?
Co-Management / Ortho consult
What is a TENS Unit and what are its benefits?
Demonstrate dispensing a TENS Unit to a patient.
A Transcutaneous Electrical Nerve Stimulation Unit is a small portable device that delivers mild electrical stimulation to the nerves and muscles. The electrical stimulation helps relax the muscles and relieve pain.
*Demo*
When migrating data from previous notes to create a new Daily Note, which visit types should you be extra mindful of?
MRI Reviews, Progress Examinations, Follow-ups, X-ray provided and Final Examinations.
All of these have the potential to change diagnoses codes.
What is a disc herniation?
A disc herniation happens when there's a tear in the disc and the soft contents inside the disc start to leak out through the tear.
The leaked content can press on nearby nerves, causing pain, numbness, or weakness in the back, arms, or legs.
What are the benefits of strengthening exercises?
*Bonus: Explain the difference between Concentric, Eccentric and Isometric contraction.
Increases bone, muscle, tendon, and ligament strength and improves posture and joint function.
Concentric - shortens the muscle
Eccentric - lengthens the muscle
Isometric - does not change the length of the muscle
Name three contraindications for getting an MRI and what is the process if there are any?
Implanted items, rods, pins, pacemaker, stents.
Go through MRI screening form and see if we need clearance, any documentation or if we are unable to scan, always follow up with MRI facility if unsure.
What is an SI belt and its benefits? Demonstrate dispensing an SI belt to a patient.
The Sacroiliac (SI) belt is a supportive brace worn around the hips to stabilize the sacroiliac joints. It stabilizes the SI joints promoting proper alignment to improve function and movement, and reduce low-back, hip and pelvic pain.
*Demo*
When should an MRI Review (99211 or 99212) and Progress Examination (99213) get a -25 modifier?
You should add a -25 modifier to 99211, 99212, and 99213 when any therapy code AND/OR adjustment code are billed in the same visit (except 96138-Cognitive Testing).
What are the planes of movement of each extremity?
Demonstrate.
Shoulder - flexion, extension, abduction, adduction, external rotation, internal rotation
Elbow - flexion, extension
Wrist - flexion, extension, ulnar deviation, radial deviation
Hip - flexion, extension, abduction, adduction, external rotation, internal rotation
Knee - flexion, extension
Ankle - plantarflexion, dorsiflexion, eversion, inversion
*Demo*