eval codes Flashcards

(43 cards)

1
Q

red flags

A

signs of serious pathology

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2
Q

orange flags

A

could be psychiatric symptoms

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3
Q

yellow flags

A

beliefs appraisal and judgements; emotional responses, pain behavior

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4
Q

blue flags

A

perceptions about the rltp b/w work and health

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5
Q

black flags

A

system or contextual obstacles

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6
Q

what is an activity limitation

A

difficulties or restrictions of an individual executing a specific task

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7
Q

what is a participation restriction?

A

difficulties or restrictions on an individual in societal aspects of functioning or in life situations
ex. work, domestic life, school, community activities

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8
Q

Examining systems eqn

A

body systems examined + body areas examined

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9
Q

the ‘other’ system category

A

level of consciousness, cognition, learning preferences, expected emotional behavior or response

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10
Q

the body systems

A

musculoskeletal, neuromuscular, cardiovascular, integumentary

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11
Q

does taking vital signs fall under a certain system?

A

no, its not really something we examination.. its a screen

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12
Q

body areas

A

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

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13
Q

When you give the final eval code you always give the highest complexity code. (T/F)

A

False, always give the lowest

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14
Q

What are the 4 names of the CPT codes

A

low complexity, moderate complexity, high complexity, re-evaluation

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15
Q

example of an unstable/unpredictable pt

A

amputee with non-healing wounds, history or frequent falls, unexplained dizziness with activity, decreased cognition, unpredictable behavior and unstable medical history

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16
Q

example of patient with evolving stability

A

musculoskeletal problem that has prolonged recovery, pregnancy, recent CVA with slow progression of return

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17
Q

who developed the CPT codes and has copyright

A

the AMA- American Medical Association

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18
Q

when were PT eval codes first used

19
Q

the new CPT codes were introduced in ___ of ___

A

January of 2017

20
Q

has the CMS adopted the 3 tiered structure for payment?

A

no.. they currently only pay one rate for a PT evaluation

21
Q

personal factors of the pt influence..

A

influence how the disability is experienced by the individual
ex. age, sex, social background, education, profession, past/current experience

22
Q

environmental factors

A

physical, social and attitudinal environment in which they live

23
Q

in order for personal factors and environmental factors to be considered they must ____

A

influence the plan of care

24
Q

a stable clinical presentation

A

patient’s condition has not changed, remained constant, straight-forward, uncomplicated

25
Low complexity in history/limitations
no personal factors or comorbidities
26
Moderate complexity in history/limitations
1-2 personal factors of comorbidities
27
High complexity in history/limitations
3+ personal factors or comorbidities
28
Low complexity in examination (body parts and systems)
adresses 1-2 examination elements
29
Moderate complexity in examination (body parts and systems)
adresses 3 examination elements
30
High complexity in examination (body parts and systems)
Addresses 4 + examination elements
31
Low complexity clinical presentation
stable
32
Moderate complexity clinical presentation
evolving
33
High complexity clinical presentation
unstable/unpredictable
34
Examination aspect consists of
tests and measures
35
Your documentation is your
PROTECTION
36
the US healthcare system uses ___ for disease codes.
ICD-10
37
Typical Insurance
blue cross, cigna, humana, united healthcare
38
non-traditional
case, work comp, personal injury, auto (other person's insurance)
39
Medicare Documentation guidelines
most comprehensive, typically adopted by other insurance carriers, APTA has worked with medicare to establish these guidelines for defensible documentation
40
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
41
MIPS/APMS and what its goal is
Merit Based Incentive Payment Program Alternative Payment Model Goal: collect data and pay for performance
42
ultimate goal of electronic medical records
one unified medical record
43
Threats to electronic medical records
data security, encryption, passwords, protection of protected health information