Name of the Procedure:

Physical Therapy; in the Home, per diem (S9131)

Summary

This procedure involves a licensed physical therapist providing physical therapy services to a patient in their home. The term "per diem" indicates that the therapy is billed on a daily basis for a specified period.

Purpose

Medical Conditions Addressed:

• Post-surgical recovery
• Chronic pain management
• Mobility issues
• Neurological conditions

Goals:

• Improve mobility and function
• Pain relief
• Enhance muscle strength
• Prevent falls
• Facilitate recovery from injury or surgery

Indications

Specific Symptoms or Conditions:

• Reduced mobility or function due to injury, disease, or surgery
• Chronic pain that limits daily activities
• Neurological diseases like stroke or multiple sclerosis
• Post-hospitalization immobility

Patient Criteria:

• Must be homebound or unable to travel to a physical therapy facility
• Physician referral typically required

Preparation

Pre-Procedure Instructions:

• No specific preparation is generally required
• Patients may need to have a quiet and spacious area in their home set up for exercises
• Wearing comfortable clothing is advisable

Diagnostic Tests/Assessments:

• Initial assessment by the physical therapist
• Review of medical history and current health status
• Possible physician evaluation and referral

Procedure Description

1. Initial Assessment:

   • The physical therapist reviews the patient's medical history and performs a physical examination.
   • Functional and mobility assessments are conducted.

2. Treatment Plan:

   • A tailored therapy plan is developed considering the patient's specific needs and goals.

3. Therapy Sessions:

   • Sessions may include exercises for strength, flexibility, and balance.
   • Manual therapy techniques may be employed.
   • Instruction on the use of mobility aids, if needed.
   • Education on home exercises to be performed independently.

Tools/Equipment:

• Resistance bands
• Weights
• Balance boards
• Mobility aids (e.g., walkers, canes)

Anesthesia/Sedation:

• Not applicable

Duration

• Each therapy session typically lasts 45 minutes to an hour.
• Frequency of sessions depends on the treatment plan, usually ranging from multiple sessions per week to daily.

Setting

• Performed in the patient's home.

Personnel

• Licensed physical therapist.

Risks and Complications

Common Risks:

• Muscle soreness
• Temporary increase in pain

Rare Risks:

• Falls or injury during exercises
• Adverse reactions to physical strain

Management:

• Close supervision during exercises
• Modification of the therapy plan as needed

Benefits

Expected Benefits:

• Improved mobility and strength
• Reduced pain
• Enhanced ability to perform daily activities
• Faster recovery from surgery or injury

Realization Timeline:

• Benefits may be noticed after a few sessions, with significant improvements over weeks to months.

Recovery

Post-Procedure Care:

• Continue prescribed home exercises
• Follow-up sessions with the physical therapist

Recovery Time:

• Varies based on individual conditions and progress; several weeks to several months.

Restrictions/Follow-up Appointments:

• Regular reassessment by the therapist to monitor progress and adjust the treatment plan.

Alternatives

Other Treatment Options:

• Outpatient physical therapy
• Occupational therapy
• Medication for pain management
• Surgical interventions for underlying conditions

Pros and Cons:

• Outpatient Physical Therapy:
  • Pros: Access to more equipment and resources
  • Cons: Requires travel
• Occupational Therapy:
  • Pros: Focuses on improving daily living skills
  • Cons: May not address specific mobility issues
• Medication:
  • Pros: Immediate pain relief
  • Cons: Does not improve mobility or strength
• Surgical Interventions:
  • Pros: May address underlying structural issues
  • Cons: Invasive with potential for complications

Patient Experience

• During Procedure:

  • Mild to moderate exertion
  • Close supervision ensures exercises are done correctly

• After Procedure:

  • Muscle soreness similar to post-exercise
  • Gradual improvements in mobility and pain levels

Pain Management:

• Heat or ice packs
• Over-the-counter pain medication if needed
• Rest and hydration

Comfort Measures:

• Regular breaks during sessions
• Supportive home environment for exercises