Lafayette, LA 70507
Phone: 337.262.1043
Fax: 337.262.1054
Intra-State Toll Free: 888.400.9110
lsbpte@laptboard.org
Declaratory Statements - Miscellaneous
06.06.21 Use of Doctor as a Title in the practice of Physical Therapy - If a physical therapist has earned a Doctorate of Physical Therapy Degree (DPT) or a Ph.D., may the physical therapist advertise as a Doctor and utilize the title in association with the practice of Physical Therapy? [ý307. Unauthorized Practice, B. A physical therapist shall use the letters "P.T." in connection with his name or place of business to denote licensure.]
Therapists who possess a Doctorate Degree should identify themselves as a Physical Therapist to patients. Physical Therapists should not allow themselves to be misinterpreted as a Medical Doctor by identifying themselves as Doctor in patient care, marketing, promotions, or advertising. It is in the best interest of the public that Physical Therapists not allow themselves to be confused as a Medical Doctor by introducing themselves as Doctor. However, in an academic setting, the title of Doctor is of choice.
Appropriate Staffing Levels - Does the Board have any documentation on what is considered appropriate staffing levels for an acute/subacute care hospital?
The Board does not have any documentation, nor can it give advice, on appropriate staffing levels or what would be considered the appropriate number of patients treated per day. However, with regards to physical therapy, the Board does not regulate supervision ratios and requirements.
Athletic Trainers in the PT setting - Can an Athletic Trainer work in the PT setting?
Please understand that athletic trainers are regulated by the Louisiana State Board of Medical Examiners, however, the Physical Therapy Board has primary jurisdiction over the practice of, and billing for, physical therapy services. Athletic trainers can work as unlicensed supportive personnel under the continuous, on the premises, supervision of a PT in the provision of physical therapy services. Athletic trainers cannot identify themselves as anything other than unlicensed supportive personnel in a physical therapy setting. There has been lengthy communication to and from the Physical Therapy Board and the Louisiana State Board of Medical Examiners with regards to the role of athletic trainers.
Billing Questions - CPT Codes - 1) Can a medical doctor with a family practice perform the following modalities within his/her office: hot/cold pack (97010), ultrasound (97035), electrical stimulation (97032), massage (97124), and therapeutic exercises (97110) without a licensed physical therapist on staff? 2) If these modalities are permissible/within the scope of practice, what training do the personnel need in order to perform said services? 3) If it is not permissible to perform/bill for these services under these CPT codes, are there any other codes that should be used instead? What are they?
1) Such modalities as defined in Question 1 are common to several medical disciplines. The Physical Therapy Practice Act and the Board's Rules and Regulations prohibit anyone from professing the practice of "physical therapy," advertising "physical therapy," and/or billing for "physical therapy." Pursuant to LSA R.S. 37:2410 B modalities may be performed in a physician?s office under his direction and may be billed under the CPT Codes as physical medicine without a licensed physical therapist on staff; however, the physician may not refer to the treatment as physical therapy, advertise as physical therapy nor bill it as physical therapy. Please be advised that ultrasound and electrical stimulation are highly skilled modalities and it is strongly suggested that these modalities be performed by a physical therapist or under his direct supervision.
2) The modalities referenced are within the scope of practice of physical therapy. The modalities are performed by an individual who is educated and licensed to practice as a physical therapist or a physical therapist assistant. Pursuant to the Physical Therapy Practice Act and the Board's Rules and Regulations, the modalities may be performed by unlicensed supportive personnel such as a technician or aide under the continuous, on premises supervision of a physical therapist. Please be advised that the physical therapist is ultimately responsible for the acts of the technicians or aides and makes the determination as to whether the technician or aide has the necessary training experience to perform such modalities.
With regards to the training of physicians and supportive personnel who work under their direction, it is suggested you contact the Louisiana State Board of Medical Examiners concerning standards of training and supervision requirements.
3) The CPT Codes which you reference are the proper codes for physical therapists to bill for physical therapy services. They are also the proper codes for the billing of physical medicine modalities by other qualified health care providers such as physicians.
Computer Database/Electronic Signature - Are PTs required to keep a hard copy of patient information in the file if it is stored electronically?
The Board does not require you to maintain a hard copy as long as the information can be accessed when needed. Additionally, electronic signatures are also valid if approved by JCAHO rules. Furthermore, the Board has approved the use of electronic signature.
Copy, reproduce, or duplicate license - In the "Chairman's Corner" of the board's newsletter, it says that a PT or PTA cannot reproduce, duplicate or copy their license, wall, or wallet in any form or fashion. Why is this? Does this mean my employer is not allowed to place and updated copy of my wallet license in my HR file each year?
Because of the improved technical abilities with copying and creating fraudulent documents, the Board has restricted the copying of licenses. An employer may verify your license with the online website of the Board, may view your license, and may phone the Board office to verify licensure status; however, copying of your license (wall or wallet) is not permitted. Please see 161.C.
LA DHH - Annual Survey of Home Health Agency - Can a physical therapist (physical therapy clinic) advertise services in a flyer, circular or newspaper?
The right to advertise is protected under the constitutional right of commercial free speech. However, the State is given the right to regulate advertisement so as to avoid false, misleading or deceptive content. Please refer to LSA R.S. 37:1721 and R.S. 37:1743. Additionally, you should also refer to the various State laws regarding unfair trade practices and consumer protection, more particularly, LSA R. S. 51:411 et seq. R.S.37: 1743 addresses the prohibitions on direct solicitations and is provided for your review as follows: A. A health care provider or person designated, contracted, or paid by the health care provider, shall not directly solicit by phone or mail, patients or potential patients who, because of their particular circumstances, are vulnerable to undue influence. Circumstances in which patients or potential patients may be considered to be vulnerable to undue influence include but are not limited to: (1) When a person is known to the health care provider to have recently been involved in a motor vehicle accident. (2) When a person is known to the health care provider to have recently been involved in a work-related accident. (3) When a person is known to the health care provider to have recently been injured by another person or as a result of another person's actions. B. Nothing in this Section shall be construed to prohibit advertising, except that which is false, misleading, or deceptive, nor to prohibit outreach services for prenatal, postpartal, child health care, and communicable disease control. C. As used in this Section, "health care provider" means any "health care provider" as defined in R. S.40: 1299.41. In defining "health care provider" R.S.40: 1299.41A(l), in pertinent part, is provided as follows: "Health care provider" means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution licensed by the state to provide health care or professional services as a ... physical therapist,...or any nonprofit facility considered tax-exempt under Section 501(c)(3), Internal Revenue code, pursuant to 26 U.S.C. 501 (c)(3), for the diagnosis and treatment of cancer or cancer-related diseases whether or not such a facility is required to be licensed by this state, or any professional corporation a health care provider is authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950, or any partnership, limited liability partnership, limited liability company, or corporation whose business is conducted principally by health care providers, or an officer, employee, partner, member, shareholder, or agent thereof acting in the course and scope of his employment. In regulating the practice of physical therapy in Louisiana, the Board is mandated by law to insure that the minimal standards of acceptable and prevailing physical therapy practice is maintained by its licensees. Pursuant to its rule making authority, more particularly, Rule 305B, the Board has included within the minimal standards of acceptable and prevailing physical therapy practice, the American Physical Therapy Association Code of Ethics, Guides for Professional Conduct, and Standards of Practice. Principle 6 of the Code of Ethics requires that "Physical therapists provide accurate information to the consumer about the profession and about those services they provide." The pertinent subsection of Principle 6 is provided as follows for your review: 6.2 Information about Services A. Information given to the public shall emphasize that individual problems cannot be treated without individualized evaluation and plans/programs of care. B. Physical therapists may advertise their services to the public. C. Physical therapists shall not use, or participate in the use of, any form of communication containing a false, plagiarized, fraudulent, misleading, deceptive, unfair or sensational statement or claim. D. A paid advertisement shall be identified as such unless it is apparent from the context that it is a paid advertisement. In summary, you have the right to advertise, however, from a regulatory standpoint such advertisements must comply with the legal requirements set forth above. The response set forth in this opinion regarding advertising is from the regulatory viewpoint of the Board. It is highly recommended that you consult with private legal counsel for advices regarding your proposed actions. This letter does not, nor is it intended to, provide an all-encompassing opinion regarding commercial free speech. Additionally, this letter does not address any applicable Federal law which may impact your decision.
Massage Therapist/Outpatient Physical Therapy Clinic - Can a licensed massage therapist identify himself as such when working as a physical therapy technician? Additionally, can the services provided by this individual be done in the same room that has been designated for his/her use?
The Board has consistently taken the position that a massage therapist can perform in the capacity of an unlicensed supportive personnel (aide/technician) when working under continuous, on the premises supervision by a licensed physical therapist. Rule 305 of the Rules and Regulations promulgated by the Board, reference the required' supervision as well as the parameters of what may be delegated to unlicensed supportive personnel by a physical therapist. Additionally, the Board has taken the position that when a massage therapist is working in the capacity of an unlicensed supportive personnel, he may not identify himself as a massage therapist nor wear any identifying badges, etc. For educational purposes, the Louisiana Legislature in the 1997 Regular Legislative Session enacted LSA R.S. 37:22 which provides that a licensed health care provider may display on his person professional credentials or identification utilizing professional licensure terms or terminology as provided for within the law or rules and regulations which govern the licensure of such health care provider. It is the Board's interpretation of the law that a licensed massage therapist is not a licensed healthcare provider. Therefore, such individual may not wear badges referencing him as a licensed massage therapist when performing as a technician in the provision of physical therapy services. The Board is concerned that the use of the same room by the massage therapist for wellness participants and physical therapy patients creates a very confusing atmosphere to the physical therapy patients when receiving physical therapy services. While it may be possible for the physical therapist and massage therapist to clearly distinguish the different hats worn by the massage therapist, from a regulatory standpoint, the possibility, if not probability, of confusion for the patient cannot be allowed by the Board. Therefore, physical therapy and massage therapy are two separate and distinct services and must be kept separate and distinct factually and in appearance. In other words, it is the Board's opinion that physical therapy services are to be performed in the physical therapy clinic or room designated for such use. In contrast, massage therapy for wellness participants and community walk-ins should be performed in a separate room specifically designated for such purpose.
Medical Records - How long are P.T.'s required to keep medical records on patients?
There are two answers to this question, each based on the type of facility in which the P.T. practices. As set forth in the Hospital Records and Retention Act, LSA R.S. 40: 2144F(l) 'Hospital Records shall be retained by hospitals in their original, microfilmed, or similarly reproduced form for a minimum period of ten years from the date a patient is discharged." In the second situation, LSA R.S. 40:1299.96A of the Health Care Information Act states "medical records of a patient maintained in a healthcare providers office are the property and business records of the health care provider." This includes the physical therapists' offices and provides as follows: "Medical Records shall be retained for a minimum period of 6 years from the date a patient is last treated..." In both cases, graphic matter images, x-ray film and like matter that were necessary to produce a diagnostic or therapeutic report shall be retained, preserved, and properly stored for a minimum of 3 years.
Nutritional Component of Tissue Healing and Arthritis Treatment - Question # 1: What legal and ethical considerations must we consider in providing information on nutrition to our patients? Question #2: Is it a breach of our practice act to recommend supplements such as glucosamine sulfate, Barley Green, Calcium supplements, or BMJ (Bone, Muscle and Joint supplement) to patients that may benefit? Question #3: Is it our place to educate these patients in nutrition when this is not in the scope, of our practice act? Question #4: If we verbally "OK" this with the patient's physician, can we recommend these various nutritional products? Question #5: Can a Physical Therapist Assistant recommend nutritional supplements if it is not in the MD's or PT's plan of care? Question #6: Is it legal to provide articles to patients regarding nutritional supplements without MD notification?
Board's Response to Question # 1:
With regards to providing nutritional information, it is suggested that you review the Nutritions' and Dieticians' Practice Act and Rules and Regulations promulgated by the Louisiana State Board of Examiners in Dietetics and Nutrition, 11930 Perkins Road, Suite B, Baton Rouge, LA 70810 which is vested with the jurisdiction of regulating such industry. The Louisiana State Board of Examiners in Dietetics and Nutrition would be in the proper position to answer your question concerning legal and ethical considerations regarding the provision of such information. You may also wish to contact the Louisiana Board of Pharmacy and possibly the Federal Agencies, such as the FDA with regards to your inquiry.
Board's Response to Question #2:
The Board has received an inquiry in the past with regards to this situation. Please find attached a copy of the Board's earlier response to such inquiry. Again, the Board is of the opinion that the provision or recommendation of supplements are not within the scope of the practice of physical therapy pursuant to the Physical Therapy Practice Act and the Board's Rules.
Board's Response to Question #3:
Educating patients on nutrition is not within the scope of the practice of physical therapy. It is suggested that you contact the State or Federal agency with the appropriate jurisdiction. See response to Question #1 above.
Board's Response to Question #4:
It is not within the scope of the practice of physical therapy to recommend these various nutritional products even with a verbal "OK" from the patient's physician. It is suggested that you contact the State or Federal agency with the appropriate jurisdiction. See response to Question # 1 above.
Board's Response to Question #5:
It is not within the scope of practice of a physical therapist assistant to recommend nutritional supplements. It is suggested that you contact the State agency with the appropriate jurisdiction in this area. See response to Question # 1 above.
Board's Response to Question #6:
It is not within the scope of the practice of physical therapy to provide articles to patients regarding nutritional supplements. It is highly suggested that you contact the Federal or State agency with the proper jurisdiction with regards to nutritional supplements. See response to Question #1 above.
Nurse Rehab Program - May a nurse rehab program be utilized for patients when there is not a physical therapist available to see the patients on a continuous basis in a home health setting?
It appears that in reality, the Nurse Rehab program is being substituted for physical therapy. The availability of physical therapy staffing should not dictate what type of professional or health care provider provides physical therapy. When a physical therapist enters a case, he must perform an initial physical therapy evaluation at which time functional problems are identified, short term and long term goals are established and a physical therapy treatment plan is implemented. Such a plan of care is to be carried out in the home health setting by the physical therapist, or a physical therapist assistant under the supervision of a physical therapist as per applicable law. Effective physical therapy treatment is usually provided two to three times a week in order to provide enough frequency and repetition for a patient to properly progress. Abdicating such responsibility to a nurse or seeking the physicians change of orders does not relieve the physical therapist of responsibility for restoring the patients function through direct care. Additionally, as long as the physical therapist is following the patient and the patient is continuing to improve, the skilled services of a physical therapist is still required. The Physical Therapist Practice Act and the Physical Therapy Board's Rules and Regulations do not authorize the physical therapist to turn over the plan of care to a nurse, but rather the only supportive personnel which is allowed by law to carry out a physical therapy treatment plan is a licensed physical therapist assistant as per certain guidelines. The Physical Therapy Board understands good intentions in trying to provide patients with care within staffing limitations. However, the Physical Therapy Board is concerned that what may actually be occurring by a Nurse Rehab program is a situation whereby a nurse is allowed to provide physical therapy. The patient/public in all probability will be easily confused by this and consider the services being provided by the rehab nurse to be physical therapy. Additionally, it may be safe to assume that the nurse could be somewhat confused and also believe she is practicing physical therapy without a license. The practice of physical therapy" is defined in the Physical Therapy Practice Act, more particularly LSA R.S. 37:2401, as follows: "...the health care profession practiced by a physical therapist under this Chapter and means the holding out of oneself to the public as a physical therapist and as being engaged in the business of, or the actual engagement in, the evaluation and treatment of any physical or medical condition to restore normal function of the neuromuscular and skeletal system, relieve pain, or prevent disability by use of physical or mechanical means, including therapeutic exercise, mobilization, passive manipulation, therapeutic modalities, and activities or devices for preventative, therapeutic, or medical purposes and further shall include physical therapy evaluation, treatment planning, instruction consultative services, and the supervision of physical therapy supportive personnel, including physical therapist assistants." When a physical therapist agrees to treat a new patient he/she must be prepared to provide physical therapy in accordance with the Physical Therapy Practice Act and the Rules and Regulations of the Physical Therapy Board. If your organization's staffing patterns are pressuring you to consider other alternatives, it is clear that you have two appropriate choices. First, your organization can recruit the appropriate physical therapy staff, or secondly, your organization should not accept the case and refer the patient to another agency or physical therapy group which can properly render physical therapy services. In reference to the newsletter article in the Physical Therapy Board's Newsletter of the Spring 1992, the language does not state, nor does intend to imply, that a physical therapist could turn over the care of a patient to a nurse. It is merely stating that the registered nurse could supplement the rehab program during her skilled nursing visit, just as reinforcement is done by all rehab professionals.
Outpatient PT Records - Question # 1: I cannot remember how long we are supposed to keep out- patient P.T. records. (And does it matter if they were private payor Medicare patients?) Question #2: And is the date of destruction from the date of initial visit or the date of discharge?
Question # 1: The Board has previously responded to questino #1 with regards to records retention in Louisiana. These are the requirements that the Board implements in regulating the practice of physical therapy regardless of whether the patients are private payor Medicare. With regards to civil issues, it is suggested you contact a private attorney with regards to your rights and obligations concerning civil issues. For example, any rights that a minor has are generally suspended until one (1) year after he reaches the age of majority. The age of majority with regards to civil rights in Louisiana is eighteen (18) years of age. In other words, if a minor child has any claim against you in a civil matter; such claim may be brought by such minor until he reaches nineteen (19) years of age. Again, the Board is not providing you with any advice regarding the age minority issue, but rather suggesting that you might want to contact a private attorney for appropriate advice.
Question #2: The time periods required in the Records Retention Acts begin to run with the last date the patient is seen by you which in all probability will be the date of discharge.
Over the Counter Drugs - Is it within the Practice Act and Rules and Regulations to sell vitamins, minerals, and/or food supplements to patients in the clinic as a convenience to our patients?
The Board is of the opinion that he sale of these products is not within the scope of practice of physical therapy, however, such provision or promotion of these products may be in violation of other applicable laws and rules and regulations concerning ?over the counter? drugs, including natural products and herbs. It is strongly recommended that you contact the Louisiana Board of Pharmacy and possibly any applicable federal agencies, such as the FDA, with regards to your inquiry and any other requirements or prohibitions concerning the provision or promotion of such products.
Over the Counter Durable Medical Equipment - If a patient or non-patient wishes to purchase an "over the counter" or an "off the shelf" product, does the person need a prescription before the therapist can provide the product? Examples would be orthoties, knee braces, etc. Is it legal to provide articles to patients regarding nutritional supplements with MD notification?
It is difficult to respond to this question due to its compound nature. However, this letter is a good faith attempt to answer the inquiry and is intended to be limited to the factual assumptions which are referenced herein. When a person approaches a physical therapist in a professional relationship, without a prescription, the physical therapist must first perform a physical therapy evaluation or consultation of a screening nature to determine the need for physical therapy treatment which may include an orthosis or brace. If the physical therapist determines that an orthosis or brace is needed as a result of the physical therapy evaluation or consultation, then a prescription from a person licensed to practice medicine, surgery, dentistry or podiatry is required by the Physical Therapy Practice Act, more particularly LSA R.S. 37:2411, in order to implement the treatment, i.e., provide the orthosis or brace.
In the event, the physical therapist determines that the individual has no symptoms or functional problems and is not a candidate for physical therapy treatment based on the physical therapy evaluation or screening, then such individual may fall within the provision of preventative services by the physical therapist and a prescription would not be required. A person (client) qualifies for preventative services when there is no acute condition or exacerbation of a chronic condition requiring physical therapy treatment. Furthermore, preventative services can not be billed to a third party payor or Medicare as physical therapy treatment.
Please be advised that the determination whether a person is a patient or non-patient (client) is fact sensitive and must be determined by a physical therapist licensed by the Board. Such determination by the physical therapist must be in accordance with the Physical Therapy Practice Act, LSA R.S. 37:2401 (a) and (d) and 37:2410A, and the Board?s Rules, more particularly Rules 305, 307D and 323A(2). Again, this response is limited by the content of this question. The Board reserves the right to amend its response based upon the receipt and review of additional information.
Ownership in PT Clinic - If all work and treatment is performed by a licensed PT, can an unlicensed lay person have any ownership in a Physical Therapy Clinic? How much or how little?
An unlicensed lay person may have ownership in a Physical Therapy Clinic - partially or entirely. However, the services of the Physical Therapy Clinic must be provided by a licensed PT in accordance with all laws and Rules and Regulations governing the practice of physical therapy in the state of Louisiana.
Physician Orders - Can the physician dictate where the patient receives physical therapy treatment?
Once a licensed physician orders physical therapy, the patient has the right to choose the physical therapist who will render treatment.
Product Endorsement - Where does the Board stand on PTs endorsing products that they recommend to patients? For example, we are writing a column for a new web site and would like to sell 2-3 of the products we recommend most to patients for the general public (e.g. Theracanes, massage oil.)
The Board is of the opinion there is no prohibition in the Physical Therapy Practice Act or the Board's Rules regarding your proposed recommendation to patients with regards to Theracanes, massage oil, etc. It is highly suggested that you contact other regulatory boards which may have jurisdiction over certain items that you are recommending to patients. For example, the Louisiana Board of Pharmacy regulates certain over the counter items, as well as the Louisiana State Board of Examiners in Dietetics and Nutrition. Additionally, please keep in mind that any form of advertisement is subject to Rules with regards to fraud, abuse, and/or deceptive practices.
"P.T." Credentials - An individual who is certified as a strength training specialist (Personal Trainer) would like to create personal business cards and flyers to market himself as such. His concern is whether or not he can use the initials "P.T." after his name.
The Physical Therapy Practice Act and the Board's Rules do not prohibit you from using the initials "P.T." on your business cards and flyers. You have earned the physical therapist degree and are licensed as such in Louisiana. However, it would be a violation of the Physical Therapy Practice Act and the Board's Rules if you practice physical therapy in violation of these laws. As required by law, you may not provide false and misleading advertisements. Such would not be the case in your scenario unless you use the "P.T." nomenclature in order to unlawfully practice physical therapy.
PT License Displayed in Clinic - I know that some states require that one's physical therapy license be displayed in full view in the clinic in which they are working, Does Louisiana require this? If so, what is the requirement for traveling and contract therapists?
Neither the Physical Therapy Practice Act nor the Board's Rules require that your license be displayed in the clinic. It is the Board's understanding that the Louisiana Department of Health and Hospitals requires that you have the license on hand for I presentation. Furthermore, please be advised that effective July 20, 2000, you cannot reproduce or otherwise copy your license or renewal card. See Rule 161.
Qualifications/PT Unlicensed Supportive Personnel - Can an individual who has not yet graduated high school perform as a physical therapy tech/aide in an in-patient setting?
Pursuant to the Physical Therapy Practice Act of Louisiana, more particularly LSA R.S. 37:2401(1)(a), the definition of the practice of physical therapy includes the supervision of physical therapy supportive personnel by a licensed physical therapist. In accordance with its delegated authority, the board has promulgated Rule 305 which specifically addresses physical therapy supportive personnel as follows: a. Physical therapy aide/technician refers to a worker not licensed by this Board who functions in a physical therapy clinic, department or business and assists with preparation of the patients for treatment and with limited patient care... c. The level of responsibility assigned to physical therapy supportive personnel is at the discretion of the physical therapist, who is ultimately responsible of the acts or omissions of these individuals. Supportive personnel may perform only those functions for which they have documented training and skills. The prohibitions for physical therapy supportive personnel shall include, but not be limited to, interpretation of referrals; performance of evaluations; initiation of adjustment of treatment programs; assumption of the responsibility for planning patient care; or any other matters as determined by the Board. The physical therapist shall only delegate portions of the treatment session to an aide/technician only after the therapist has assessed the patient's status. The above cited Rule sets forth the obligations and prohibitions regarding physical therapy supportive personnel as well as the fact that the physical therapist is ultimately responsible for the acts or ommissions of these individuals. It also states that the physical therapist shall only delegate portions of the treatment sessions to an aide/technician only after the therapist has assessed the patient's status. With regards to the age of a physical therapy technician/aide, the Physical Therapy Practice Act nor the Board's Rules address such issue. However, please be advised that the physical therapist is ultimately responsible for the acts or omissions of such an individual. As I am sure you will agree, certain maturity and responsibility comes with age. It is highly recommended that you review any applicable medicare guidelines, child labor laws, School board rules, etc. with regards to hiring a young person who has not yet graduated from high school. There may be guidelines or prohibitions by the entities who administer these laws or rules.
Restorative Program - PT Care - I work in a hospital. We are looking at the possibility of implementing a restorative program to assist patients on various units who need continued ROM, gait, etc. but do not need the skill of a PT any longer. We are finding that there are occasions that the physician may not want to d/c PT services because he wants the patient to continue with mobility but that patient no longer is meeting goals and should be discharged My question is: Can a restorative program be implemented under the PM&R department or would the staff performing the restorative program be considered support staff and therefore need supervision from the PT? What we are considering is training the staff, implementing the program, and coordinating who that staff member or members should be seeing, but not having any further contact than that. If the PM&R department cannot oversee this program, then our plan is to assist nursing in implementing the program.
First, a Restorative Program should properly function outside of the Physical Therapy Department and may be better administered under the Nursing Department under the direction and supervision, of a nurse. In this way, there is no confusion on the part of any patient, family or physician as to I whether the patient is continuing Physical Therapy Services. The PT staff may assist in the training of personnel and may coordinate the referral of patients to the Restorative program.
The Board is assuming that employees of the Restorative program are non-licensed individuals that will be referred to as mobility aides or restorative aides. They should in no way be identified as physical therapy aides nor should the service be billed as physical therapy.
As you mentioned, patients would be referred to the Restorative Program once the PT has evaluated the patient and determined that the patient has no need for the skilled services of a physical therapist or once a physical therapy patient has completed their treatment program and the patient no longer requires the skills of a therapist. The PT would properly discharge the patient and potentially refer the patient to the Restorative program. The Restorative program essentially functions to carry out a home mobility program as a family member or caretaker would in the patient's home environment.
Respiratory Therapy - What does "CPT" mean when used by a respiratory therapist?
The Board reviewed the Respiratory Practice Act and the Rules and Regulations promulgated by the Board of Medical Examiners regarding respiratory therapy. More particularly, the statute and regulations provide that "CPT" -references and is defined as Chest Pulmonary Therapy. Therefore, the Board has taken the position that it is within the scope and practice of a respiratory therapist to reference CPT or Chest Pulmonary Therapy with regards to its documentation and billing. However, the Board is of the opinion that "chest physical therapy" is a violation of the Physical Therapy Practice Act of Louisiana and the Rules and Regulations promulgated by this Board
Restorative Services - Are restorative services performed by a restorative aide part of physical therapy in a long term care facility?
A "restorative aide" is usually under nursing authority and is not a physical therapy technician/aide. If the physical therapist discharges the patient in a long term care facility to restorative services and physical therapy is no longer needed nor provided by the physical therapist, or under his supervision requirements for supportive personnel, such restorative services are not part of physical therapy treatment and therefore cannot be billed as physical therapy. This is predicated upon the fact that the physical therapist discharged the patient.
Work hardening or re-conditioning? - Are clinics licensed for work hardening or re-conditioning?
The Board does not license "clinics" regarding work hardening, re-conditioning or any other matter. Pursuant to the Physical Therapy Practice Act and the Rules and Regulations promulgated by the Board, the Board is vested with the authority to license individuals. A.PTA has set standards for Work Hardening and Work Conditioning Programs. These standards may be obtained from APTA, Department of Practice.
Athletic event - 1. Can a physical therapist evaluate a football player on the field/sideline; and report the findings to a physician by phone and receive a verbal order from the physician to implement treatment? 2. Are crutch instructions considered first aid or treatment? 3. Would taping be considered preventive or intervention in the following scenario: a student requests taping and indicates that he had injured himself recently, but has not seen a physician regarding the injury?
(1) The Board determined that a physical therapist can evaluate a player on the field/sideline and report the findings to a physician and receive a verbal order to implement treatment.
(2) The Board determined that at an athletic event, instructing a player in crutch walking would be considered first aid. The physical therapist should exercise great caution regarding instructions with any weight bearing status.
(3) Taping of a previously injured athlete who has not seen a physician and determined that in this scenario taping would be considered intervention or treatment, and therefore would require a written diagnosis prior to treatment.
