Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.
Physical Therapy:
Terms and Definitions
Accepted Standard of Practice
The following documentation requirements constitute the accepted standard of practice in providing physical therapy.
Physical Therapy Initial Evaluation
• patient name, date of birth and Social Security Number
• presenting complaints/subjective findings
• objective findings/test results
• evaluation/assessment of patient status
• recommended treatment plan
• rehabilitation goals
• anticipated frequency/length of treatment
• signature of licensed person performing evaluation
Physical Therapy Daily Progress Notes
• date of treatment
• treatment given
• subjective findings
• objective findings
• response to treatment
• therapy provider’s signature
Physical Therapy Weekly Progress Notes
• dates of treatment
• treatment given
• subjective and objective findings
• response to treatment
• therapy provider’s signature
Physical Therapy
Summary Progress Notes
• subjective changes in patient status
• initial goals and progress toward goals
• measurable objective changes in patient status
• need for modification of goals or treatment plan
• anticipated frequency and length of future treatment
• therapy provider’s signature
Medical files which do not contain the information included in the physical therapy progress notes indicate treatment that is substandard in the industry. Such information should be duly noted and recorded.
PHYSICAL THERAPY EQUIPMENT/MODALITIES
Suspect claims usually involve multiple claimants with extremely similar, or even identical, injuries. Even when injuries vary among the various participants, the treatment modalities might be identical or extremely similar.
There are a number of standard modalities used, involving various items of physical therapy equipment, and the professional investigator should be familiar with the most common of these.
Acupuncture
Less common than many others, this modality is used from time to time, particularly at clinics owned by or employing Oriental doctors, licensed to practice acupuncture.
As such, it is a healing art in its own right, requiring licensure and, in fact, separate from a physical therapy modality. However, Oriental-owned clinics will, on occasion, confuse the two practices and violations may occur.
Acupuncture involves the use of needles placed into the patient’s skin at various grid junctures running vertically and horizontally on the human body, as illustrated by acupuncturist’s charts.
Body Toner
A leather bound treatment table with three different functions:
heat, vibration and intersegmental traction. A common brand name associated with this equipment is “Orthion Table.”
The vibration and heat modes of this equipment are self-explanatory. The intersegmental traction is also referred to as “massage,” or “roller massage,” by patients. A common description of this equipment by patient/ claimants unfamiliar with physical therapy is “a bed with rollers.”
The mechanical rollers, just beneath the surface of the leather cover, exert upward pressure on the patient’s back, as she or he lies face up on the table. The rollers not only act to massage the muscles of the back, they also create a slight amount of traction on the vertebrae, reversing the compression caused by injuries that tend to squeeze the vertebral discs and reduce the normal disc spaces.
Cryotherapy
Literally, cold cure. Although it can refer to a number of different modalities associated with ice or cold producing equipment or products, this term is usually associated with ice packs.
Diathermy
Diathermy involves the use of heat, as the term “therm” implies. The diathermy instrument is a device which applies electrically generated heat to the affected muscles.
Electrical Muscle Stimulation
Electrical muscle stimulation is one of the more common treatments in many clinics. This modality is usually administered by attaching two electrodes, connected to adhesive patches, to an upper and lower portion of the affected area. An electrical current is then passed through the surrounding area, in order to stimulate the affected muscles.
Fomentation
The application of warm, moist substances.
Hot/Cold Packs
Hot packs, cold packs (or both) are also fairly common therapy.
These are sometimes described by some claimants as “hot towels.” You may find that claimants use all manner of odd names or descriptions for therapy received.
Hydrocollator packs
Hot packs.
Hydrotherapy
Literally, water cure. This usually refers to a whirlpool bath, or a spa. Stainless steel portable units are quite common, and normally large enough for only one person at a time (not likely to be found at social gatherings or large parties for hot tubbing).
Massage
Massage is almost universal in the treatment of soft tissue injuries and may be either manual, by hand held vibrator, vibration table, body toner (Orthion) or a combination.
Orthion Table
A brand name for the equipment generally referred to as a “body toner.” This modality is quite common and frequently described by patients as “a table (or bed) with rollers.” This is an apt description, as the device, in this mode, activates a bar or rollers which push upward into the back as the patient lies face up, rolling up and down the patient’s back.
The amount of upward pressure can be adjusted, as needed, to increase or decrease the force exerted on the back muscles and spinal column.
You may see this modality listed in clinic billing statements under its brand name, or as intersegmental traction, or mechanical massage. (See also “Body Toner.”)
Sonicator
The sonicator is a brand name used for ultrasound.
TENS
This is an abbreviation for Transcutaneous Electrical Nerve Stimulation. This therapy is similar to electrical muscle stimulation.
Traction
Various forms of traction may be used, such as intersegmental traction (see Orthion table) or mechanical or manual traction. Intersegmental or mechanical traction usually involves the use of tables or machines to which the patient is secured at some portion of the spinal column. Weight settings are then adjusted according to need, and the machine gently pulls the compressed vertebrae apart, establishing a more normal disc space.
Manual traction usually involves the use of pulleys and weights, achieving basically the same result. For example, a harness may be attached to the head. A line runs from the harness to a pulley high on a wall. The other end of the line is attached to just the right amount of weight and traction is applied to the cervical vertebrae.
Ultrasound
Ultrasound involves the use of a device which produces ultrasonic waves, used to stimulate the muscles. This modality is also fairly common and frequently found on itemized statements sent from the treating clinic.
Ultrasound is generally administered by first applying a gel to the affected area. The wave length intensity is set and the hand held portion of the unit is then moved back and forth over the area where the gel was applied.
Vibration Table
Another function of the “Body Toner” or “Orthion Table.” This equipment is just as the name implies. The table has various settings that allow for adjustment of the strength of the vibration. The purpose is to relax tense or spasmodic muscles and encourage them to release, at least enough to attempt spinal or myomanipulation.
In addition to “Orthion Table,” which is perhaps the most common term you will hear for this equipment, the bed is also referred to by patients as a vibration table. See also “Body Toner.”
You may find additional modalities and equipment in the course of your investigations; however, these are the most commonly found methods of physical therapy, and will give you a good working knowledge of what you’re likely to encounter in the field.
COMMON MEDICAL TERMS
The following are a list of medical terms encountered in a review of any given medical file. We have not included every possible term you may encounter, but have limited our discussion to those terms which are of concern to your specific objectives and are most commonly found.
The following are terms you should know, or will be likely to find during the course of a medical file review.
acute – severe and sudden onset; opposite of chronic.
antalgic – in order to reduce pain; patients are said to be in an antalgic position in an attempt to alleviate pain caused by normal movement.
anterior – toward the front.
bilaterally – on both sides.
cervical – relating to the cervical spine; the neck.
cervicalgia – neck pain.
cephalalgia – headache (see also paresthesia).
chronic – of long standing duration; lingering.
disc – referring to the vertebral disc, a small cartilaginous disk separating one vertebra from another.
degenerative – that which causes a degeneration; the process of degeneration.
dextro – a prefix meaning toward the right.
dynamometer – a diagnostic tool for measuring grip strength.
dysphagia – swallowing difficulty.
extension – opposite of flexion or contracture.
flexion – to flex or cause a particular muscle to contract.
fomentation – the application of warm, moist substances.
gait – stride; manner of walking.
hemoptysis – spitting blood.
inferior – below; the lower portion.
lateral – toward the side.
levo – a prefix meaning toward the left.
lordosis/lordotic – referring to the natural curve of the spine.
lumbago – back pain, specifically in the lumbar spine.
lumbar – the low back region above the sacral spine and below the thoracic spine, where no ribs attach.
luxation – dislocation (see also subluxation).
myofascitis – an irritation or inflammation of the fascia, a thin layer of connective tissue that covers and supports the muscles.
myospasm – muscle spasm.
objective – in our context, this refers to those symptoms which a doctor can see, hear or feel.
occipital – the posterior aspect of the skull; the back of the head.
osteophyte – a growth or build up of deposits on the bone.
palpable – able to be felt, or perceived by touch.
palpation – the act of feeling, as with the hand.
palpitation – abnormally fast heartbeat.
paresthesia – headache (see also cephalalgia).
paravertebral – alongside the vertebrae.
pathology – referring to disease, or the nature, cause or result of disease.
posterior – toward the rear; behind.
radiculitis – pain associated with nerve roots.
radiographic – relating to x-rays.
radiology – the science of x-rays.
roentgenology – the study of or use of x-rays in diagnosing or treating disease. From the German scientist Wilhelm Konrad Roentgen who discovered x-rays.
sacral – of the sacrum; that portion of the spinal column below the lumbar spine.
scoliosis – an abnormal lateral curvature of the spinal column.
spasm – a sudden and involuntary contraction of a muscle or muscles.
splenius – one of two large, flat muscles on either side of the posterior neck, by which the head and neck rotate.
spondylosis – disease of the vertebrae.
subjective – in our context, this refers to those symptoms which the patient tells the doctor about.
subluxation – a partial dislocation, or misalignment, usually in reference to the spinal column and corrected with chiropractic adjustments (see also luxation).
suboccipital – behind or below the occipital bone or back of the head.
superior – above; the upper portion.
trapezius – large muscles on either side of the neck at the base, and the upper shoulders.
thoracic – referring to the thorax. When used in reference to the thoracic spine, refers to that part of the spinal column below the cervical spine and above the lumbar spine. That portion of the spine to which the ribs are attached.
You may, from time to time, encounter medical terms with which you are not familiar and which are not found in this brief list of definitions. It would therefore be to your advantage to obtain a good quality medical dictionary or at least an exhaustive, unabridged English dictionary, such as Webster’s, which will contain most words you’ll be likely to encounter during the course of your medical audits.
Eric Tackett, a former law enforcement investigator, is currently active as a private investigator, specializing in insurance fraud investigations. He is a published author and training instructor. The above information is an except from his book, “The Investigative Medical Audit”.
© Copyright 1995 The John Cooke Fraud Report