Pelvic Pre-calculated G-Code Modifier Tables

Transcription

1 Pelvic Pre-calculated G-Code Modifier Tables COLORECTAL-ANAL DISTRESS INVENTORY 8 (CRADI-8) FECAL INCONTINENCE QUALITY OF LIFE INSTRUMENT FEMALE SEXUAL FUNCTION INDEX (FSFI) FEMALE NIH CHRONIC PROSTATIS SYMPTOM INDEX (CPSI) INCONTINENCE IMPACT QUESTIONNAIRE INTERNATIONAL PROSTATE SYMPTOM SCORE NIH CHRONIC PROSTATIS SYMPTOM INDEX (NIH-CPSI) FOR MALES PAIN DISABILITY INDEX PATIENT SPECIFIC FUNCTIONAL SCALE PELVIC FLOOR DISTRESS INVENTORY- SHORT FORM 20 (PFDI-20) PELVIC ORGAN PROLAPSE DISTRESS INVENTORY 6 (POPDI-6) PELVIC ORGAN PROLAPSE/URINARY INCONTINENCE SEXUAL FUNCTION QUESTIONNAIRE (PISQ-12) PROSTATITIS SYMPTOMS QUESTIONNAIRE UROGENITAL DISTRESS INVENTORY (UDI-6) VULVAR PAIN FUNCTIONAL QUESTIONNAIRE (V-Q) Whole number scores calculated to percentage to find end ranges. Each end ranges retested to ensure correct modifier assignment. The Fecal Incontinence Quality of Life Instrument and the Female Sexual Function Index were scored by subtracting the lowest possible score from the highest possible score, then finding 20% of the difference and setting the range endpoints based on that 20%. Components of PFDI-20 and the PISQ-12 were scored officially in the first table and with raw scores to correlate to modifiers in the second table. The purpose of this is to save time by eliminating the additional calculations required for the official scoring. Tests included in this list provide a range of options for documenting a patient s dysfunction. The ranges are for levels of impairment, limitation, or restriction as listed on If the APTA SoWH produces a list of which tests are acceptable and unacceptable to use, this table will be modified and will be able to be found at Currently, no such list of acceptable tests exists, and modifiers are based on outcome measures or clinical judgment. The intent of these tables is to save time and create fewer errors. It is the responsibility of the PT to use clinical judgment in choosing the best possible test for her need. Created by: Heather Edwards, MPT Produced and Distributed by: Tracy Sher, MPT, CSCS All rights reserved. Pelvic Guru

2 COLORECTAL-ANAL DISTRESS INVENTORY 8 (CRADI-8)* Officialscoring: 1@19 1@19%IMPAIRED CI 20@39 20@39%IMPAIRED CJ 40@59 40@59%IMPAIRED CK 60@79 60@79%IMPAIRED CL 80@99 80@99%IMPAIRED CM %IMPAIRED CN Shortcutfromrawscoresthatwillgivethesamemodifiersasabove(thesearenotofficialscoresfor thetests,onlywaysofgettingamodifierwith2fewercalculations): 1@6 1@19%IMPAIRED CI 7@12 20@39%IMPAIRED CJ 13@19 40@59%IMPAIRED CK 20@25 60@79%IMPAIRED CL 26@31 80@99%IMPAIRED CM %IMPAIRED CN FECAL INCONTINENCE QUALITY OF LIFE INSTRUMENT 16 0%IMPAIRED CH 13.7@15.9 1@19%IMPAIRED CI 11.3@ @39%IMPAIRED CJ 8.9@ @59%IMPAIRED CK 6.5@8.8 60@79%IMPAIRED CL 4.1@6.4 80@99%IMPAIRED CM 4 100%IMPAIRED CN FEMALE SEXUAL FUNCTION INDEX (FSFI) 36 0%IMPAIRED CH 30@35 1@19%IMPAIRED CI 23@29 20@39%IMPAIRED CJ 17@22 40@59%IMPAIRED CK 10@16 60@79%IMPAIRED CL 3@9 80@99%IMPAIRED CM 2 100%IMPAIRED CN 2

3 FEMALE NIH CHRONIC PROSTATITIS SYMPTOM INDEX (CPSI) Pain: CI CJ CK CL CM %IMPAIRED CN Urinary Symptoms: 1 1@19%IMPAIRED CI 2@3 20@39%IMPAIRED CJ 4@5 40@59%IMPAIRED CK 6@7 60@79%IMPAIRED CL 8@9 80@99%IMPAIRED CM %IMPAIRED CN Quality of Life Index: 1@2 1@19%IMPAIRED CI 3@4 20@39%IMPAIRED CJ 5@7 40@59%IMPAIRED CK 8@9 60@79%IMPAIRED CL 10@11 80@99%IMPAIRED CM %IMPAIRED CN INCONTINENCE IMPACT QUESTIONNAIRE 1@4 1@19%IMPAIRED CI 5@8 20@39%IMPAIRED CJ 9@12 40@59%IMPAIRED CK 13@16 60@79%IMPAIRED CL 17@20 80@99%IMPAIRED CM %IMPAIRED CN 3

4 INTERNATIONAL PROSTATE SYMPTOM SCORE CI CJ CK CL CM %IMPAIRED CN NIH CHRONIC PROSTATITIS SYMPTOM INDEX (NIH-CPSI) FOR MALES Pain: CI CJ CK CL CM %IMPAIRED CN Urinary Symptoms: 1 1@19%IMPAIRED CI 2@3 20@39%IMPAIRED CJ 4@5 40@59%IMPAIRED CK 6@7 60@79%IMPAIRED CL 8@9 80@99%IMPAIRED CM %IMPAIRED CN Quality of Life Index: 1@2 1@19%IMPAIRED CI 3@4 20@39%IMPAIRED CJ 5@7 40@59%IMPAIRED CK 8@9 60@79%IMPAIRED CL 10@11 80@99%IMPAIRED CM %IMPAIRED CN 4

5 PAIN DISABILITY INDEX CI CJ CK CL CM %IMPAIRED CN PATIENT SPECIFIC FUNCTIONAL SCALE 5activities: 5 41@49 1@19%IMPAIRED CI 31@40 20@39%IMPAIRED CJ 21@30 40@59%IMPAIRED CK 11@20 60@79%IMPAIRED CL 1@10 80@99%IMPAIRED CM 0 100%IMPAIRED CN 4activities: 4 33@39 1@19%IMPAIRED CI 25@32 20@39%IMPAIRED CJ 17@24 40@59%IMPAIRED CK 9@16 60@79%IMPAIRED CL 1@8 80@99%IMPAIRED CM 0 100%IMPAIRED CN 3activities: 3 25@29 1@19%IMPAIRED CI 19@24 20@39%IMPAIRED CJ 13@18 40@59%IMPAIRED CK 7@12 60@79%IMPAIRED CL 1@6 80@99%IMPAIRED CM 0 100%IMPAIRED CN 5

6 PELVIC FLOOR DISTRESS INVENTORY-SHORT FORM 20 (PFDI-20) CI CJ CK CL CM %IMPAIRED CN PELVIC ORGAN PROLAPSE DISTRESS QUESTIONNAIRE 6 (POPDI-6)* Officialscoring: 1@19 1@19%IMPAIRED CI 20@39 20@39%IMPAIRED CJ 40@59 40@59%IMPAIRED CK 60@79 60@79%IMPAIRED CL 80@99 80@99%IMPAIRED CM %IMPAIRED CN Shortcutfromrawscoresthatwillgivethesamemodifiersasabove(thesearenotofficialscoresfor thetests,onlywaysofgettingamodifierwith2fewercalculations): 1@4 1@19%IMPAIRED CI 5@9 20@39%IMPAIRED CJ 10@14 40@59%IMPAIRED CK 15@19 60@79%IMPAIRED CL 20@23 80@99%IMPAIRED CM %IMPAIRED CN 6

7 PELVIC ORGAN PROLAPSE/URINARY INCONTINENCE SEXUAL QUESTIONNAIRE (PISQ-12) Officialscoring: CI CJ CK CL CM %IMPAIRED CN Shortcutfromrawscoresthatwillgivethesamemodifiersasabove(thesearenotofficialscoresfor thetests,onlywaysofgettingamodifierwith2fewercalculations): CI CJ CK CL CM %IMPAIRED CN PROSTATIS SYMPTOMS QUESTIONNAIRE (PSQ) Pain: CI CJ CK CL CM %IMPAIRED CN UrinarySymptoms: 1 1@19%IMPAIRED CI 2@3 20@39%IMPAIRED CJ 4@5 40@59%IMPAIRED CK 6@7 60@79%IMPAIRED CL 8@9 80@99%IMPAIRED CM %IMPAIRED CN 7

8 QualityofLifeImpact: CI CJ CK CL CM %IMPAIRED CN URINARY DISTRESS INVENTORY (UDI-6)* Officialscoring: CI CJ CK CL CM %IMPAIRED CN Shortcutfromrawscoresthatwillgivethesamemodifiersasabove(thesearenotofficialscoresfor thetests,onlywaysofgettingamodifierwith2fewercalculations): CI CJ CK CL CM %IMPAIRED CN VULVAR PAIN FUNCTIONAL QUESTIONNAIRE (V-Q) CI CJ CK CL CM %IMPAIRED CN *These tests are also part of the PFDI-20. 8