Reimbursement  Codes

How can I assure reimbursement for isokinetics?

To assure effective rehabilitation, you need to know, communicate and prove each of the following points - isokinetics gives you the answers.

• What is the clinical status of the patient and how does it influence function?
• What is the most appropriate treatment for the patient?
• How much treatment will be required?
• Has the patient been rehabilitated?
• That there is NO less intensive or more appropriate evaluation or treatment alternative.

Issue 1:

What is the clinical status of the patient and how does it influence function?

Disease leads to impairment, impairment leads to functional limitations and functional limitations lead to disability. Physicians, therapists and athletic trainers have relied on isokinetic testing for quantification of musculoskeletal performance impairments. The impairment is expressed as a deficit in a muscle's ability to produce force, perform work,or generate power. All the referenced studies use isokinetic assessments to establish baselines and goals for criterion based rehab programs.

Issue 2:

What is the most appropriate treatment for the patient?

The referenced studies document treatment programs for many common pathologies. When used in conjunction with evidence-based protocols, the isokinetic data allows the clinician to make the appropriate changes to the clinic activity portion and/or the home based portion of the program. The isokinetic data may also show that a patient is no longer responding to therapy or that therapy should be discontinued.

Issue 3:

How much treatment will be required?

These studies document that even with complex problems, ACLs, shoulder impingement, arthroscopic subacromial decompression, rotator cuff and ankle instability, that there are fairly consistent and predictive time frames for returning to different levels of function.

Wilk (1992) documents the status of 250 ACL reconstructed knees at 12 weeks post-op. Timm (1988) shows the results after an average of 8.9 weeks of rehab for post-surgical knees.

Issue 4:

Has the patient been rehabilitated?

All the studies show a correlation between the rehab program, isokinetic data and return to functional activities. The study by Timm (1988) documents that isokinetic exercised based programs are more efficient and effective than non-isokinetic programs. Wilk (1991, 1992) follow-up studies with ACL patients 12 weeks and 6 months post-op document successful rehab programs. The study by Ambrosios (1994), showed the average therapy sessions for a non-surgical group was 4.39 weeks versus 7.59 weeks for the surgical intervention group. The cost of therapy was twice as much for the surgical group. Both groups achieved a high return to work rate: surgical 84%, non-surgical 98%.

Issue 5:

Is there a less intensive or more appropriate diagnostic or treatment alternative?

No. Some consider a manual muscle test as an alternative for measuring strength. Many references to the problems associated with a manual muscle test are cited in Wilk (1991) and Kulman (1992). These problems include consistency in grading and method, subjectivity in reporting, and poor inter-tester reliability. Also, manual muscle tests are performed statically, whereas isokinetic testing renders objective reliable data regarding muscular performance during a dynamic contraction.

["...isokinetic testing renders objective reliable data regarding muscular performance during a dynamic contraction."]
(Wilk 1991)

The medical providers that utilize isokinetics are telling the insurance companies that they want to control costs and manage cases objectively towards a positive outcome. Insurance companies that reimburse for isokinetic tests are telling providers they expect objective case management.

Don't take our word, check the facts...

References:

Knee

1. Timm, K.E.: Post-surgical Knee Rehabilitation: A five year study of four methods and 5,381 patients. Am J Sports Med 16(5):463-468, 1988.

2. Noyes. F.R., et al: Bone-Patellar Ligament and Fascia Lata Allografts for Reconstruction of Anterior Cruciate Ligament. JK. Bone Joint Surg 72-A(8):1125-1136, Sept. 1990.

3. Snyder-Mackler L., et al: Strength of the Quadricpes Femoris Muscle and Functional Recovery after Reconstruction of the Anterior Cruciate Ligament. J. Bone Joint Surg 77-A(8):1166-1173, Aug. 1995.

4. Wilk, K., et al: Current Concepts in the Treatment of Anterior Cruciate Ligament Disruption. JOSPT 15(6):279-293, June 1992.

5. Wilk, K., et al: Anterior Cruciate Ligament Reconstruction Rehabilitation: A 12-week Follow-up of Isokinetic Testing in Recreational Athletes. Isokinetics Exer Sci 2(2):82-91, 1992.

6. Wilk, K., et al: Anterior Cruciate Ligament Reconstruction Rehabilitation: A Six Month Follow-up of Isokinetic Testing in Recreational Athletes. Isokinetics Exer Sci 1(1):36-43, 1991.

7. Wilk, K., et al: The Relationship Between Subjective Knee Scores, Isokinetic Testing, and Functional Testing in the ACL-Reconstructed Knee. JOSPT 20(2):60-73, Aug. 1994.

Shoulder

8. Ben-Yeshay, M., et al: Pain Inhibition of Shoulder Strength in Patients with Impingement Syndrome. Orthopedics 17(8), Aug. 1994.

9. Wilk, K., et al: Rehabilitation Following Arthorscopic Subacromial Decompression. Orthopedics 16(3): 349-358, Mar. 1993.

10. Brewster, C., et al: Rehabilitation of the Shoulder Following Rotator Cuff Injury or Surgery. JOSPT 18(2), Aug. 1993.

11. Warner, J., et al: Patterns of Flexibility, Laxity and Strength in Normal Shoulder and Shoulders with Instability and Impingement. Am J Sports Med 18(4):366-375, 1990.

12. Wilk, K., et al: Standardized Isokinetic Testing Protocol for the Throwing Shoulder: The Throwers' Series. Isokinetics Exer Sci 1(2):63-71, 1991.

13. Kuhlman, J., et al: Isokinetic and Isometric Measurement of Strength of External Rotation and Abduction of the Shoulder. JBJS 74-A(9):1320-1333, 1992.

Ankle

14. Gross, M.T., et al: Relationship Between Multiple Predictor Variables and Normal Biodex Eversion-Inversion Peak Torque and Angular Work. JOSPT 15(1):24-31, Jan. 1992.

15. DeMaio, M., et al: Chronic Lateral Ankle Instability-Inversion Sprains: Part I. Orthopedics 15(1):87-96, 1992.

16. DeMaio, M., et al: Chronic Lateral Ankle Instability-Inversion Sprains: Part II. Orthopedics 15(2):241-248, 1992.

17. Wilkerson, G., et al: Invertor vs. Evertor Peak Torque and Power Deficiencies Associated with Lateral Ankle Ligament Injury. JOSPT 26(2), Aug. 1997.

Elbow

18. Andrews, J., et al: Physical Examination of the Thrower's Elbow. JOSPT 17(6):296-304, June, 1993.

Back

19. Ambrosios, F.M., et al: A Preliminary Comparison of Isokinetic Data Among Back Injured Surgical and Non-Surgical Patients, and the Effect of a Functional Restoration Program on their Ability to Return to