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TREATMENT PLAN
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Treatment Plan Status
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Patient Treatment Plan
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Goals
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Spinal Complaint #1 - Short Term Goals
• • •
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Spinal Complaint #1 - Long Term Goals
• • •
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Spinal Complaint #2 - Short Term Goals
• • •
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Spinal Complaint #2 - Long Term Goals
• • •
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Spinal Complaint #3 - Short Term Goals
• • •
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Spinal Complaint #3 - Long Term Goals
• • •
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Extremity Complaint #1 - Short Term Goals
• • •
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Extremity Complaint #1 - Long Term Goals
• • •
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Extremity Complaint #2 - Short Term Goals
• • •
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Extremity Complaint #2 - Long Term Goals
• • •
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Other Complaint #1 - Short Term Goals
• • •
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Other Complaint #1 - Long Term Goals
• • •
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E/M CODES
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No Exam was performed today
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Initial Exam performed today
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Re-Exam performed today
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Review of Findings (Day 2)
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99202 (Eval and notes 15-29 mins)
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99212 (Eval and notes 10-19 mins)
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99203 (Eval and notes 30-44 mins)
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99213 (Eval and notes 20-29 mins)
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99204 (Eval and notes 45-59 mins)
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99212 - 2nd Day ROF
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99213 - 2nd Day ROF
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DIAGNOSTIC CODES
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No X-Rays were performed today
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Cervical X-rays
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Rationale:
• • •
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72040 (2-3 Views)
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72050 (4-5 Views)
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Thoracic X-Rays
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Rationale:
• • •
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72070 (2 Views)
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72072 (3 Views)
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Lumbar X-Rays
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Rationale:
• • •
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72100 (2-3 Views)
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72110 (4+ Views)
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Upper Extremity X-Rays
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Rationale:
• • •
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73020 Shoulder 1 View
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73030 Shoulder 2+ Views
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73070 Elbow 2+Views
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73100 Wrist 2 Views
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73120 Hand 2 Views
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73140 Finger(s) 2 views
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Lower Extremity X-Rays
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Rationale:
• • •
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73500 Hip (Unilateral) 1 View
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73510 Hip (Unilateral) 2 Views
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73560 Knee 1-2 Views
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73562 Knee 3 Views
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73600 Ankle 2 Views
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73610 Ankle 3+ Views
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73620 Foot 2 Views
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73630 Foot 3+ Views
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DME's PROVIDED
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No DME's were provided today
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Vive Cervical Collar
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Vive Lumbar Support
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Vive XL Lumbar Support
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CORETECH 627 LSO Back Brace
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Vive Arm Sling
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Vive Wrist Brace
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Vive Knee Brace
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Vive Ankle Brace
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Ice Pack (Mark Units!)
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Biofreeze
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Electrodes
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LidoPro Patch
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Mohey Box (At-Home Therapy)
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LEVEL OF ADJUSTMENT PERFORMED
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No adjustment performed today
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Type of Adjustment Performed
• • •
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98940 (1-2 Regions)
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98941 (3-4 Regions)
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98942 (5 Regions)
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98943 (Extremity)
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THERAPIES PROVIDED
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No Therapies provided today
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97110 Therapeutic Exercise 1 Unit
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97110 Therapeutic Exercise 2 Units
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97530 Therapeutic Activities 1 Unit
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97530 Therapeutic Activities 2 Units
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97112 Neuromuscular Re-Education 1 Unit
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97112 Neuromuscular Re-Education 2 Units
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97140 Manual Therapy 1 Unit
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97140 Manual Therapy 2 Units
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97535 Self-Home Management
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98960 Patient Education
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97035 Ultrasound
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97012 Mechanical Traction
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G0283 Electrical Stimulation 1 Unit
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97010 Hot / Cold Therapy
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KT Tape
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29240 Strapping of Shoulder
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29260 Strapping of Elbow or Wrist
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29280 Strapping of Hand or Finger
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29520 Strapping of Hip
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29530 Strapping of Knee
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29540 Strapping of Ankle or Foot
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ADDITIONAL COMMENTS
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Insert any additional comments here...
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