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  • New POS Code Established at APTA's Urging

    APTA's request for a new place of service (POS) code to indicate that a physical therapist (PT) delivered services at a patient’s worksite recently was granted by the Centers for Medicare and Medicaid Services (CMS). Place of service codes are 2-digit codes placed on health care claims to indicate the setting in which a service was provided. The new code is available for use effective January 1, 2013, but will not be effective for Medicare until May 1, 2013.

    The new code, POS 18, is named "place of employment-worksite." Per the description, the code should be used when physical therapy is delivered at "A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual."

    PTs delivering services that are appropriately reported using POS codes should check with payers to determine if they are prepared to accept POS 18.

    Examples of situations in which POS 18 can be used include, but are not limited to:

    • Job site analysis to identify potential accommodations – patient present and participating in the service
    • Job coaching to improve biomechanics at the work site – patient present and participating in the service
    • Physical therapy evaluation and treatment at the worksite
    • Functional capacity evaluations at the worksite to determine the worker's ability to perform specific job duties

    Currently, PTs are likely to report POS 99, known as "other place of service," when delivering services at the worksite. The addition of POS 18 will enable PTs, payers, and others using POS code data to more accurately identify where services are delivered. Health plans can use this information to implement payment differentials when providers are required to travel in order to deliver services, and to study the costs and benefits of alternative service delivery options.

    In its request to CMS for the new POS code, APTA noted that the provision of physical therapy (and other medical) services at the place of work reduces lost productivity, enhances the effectiveness of job-specific training, and improves access to services where transportation and other barriers may exist. The association also told the agency that workers are more likely to receive the health care services they need in order to remain productive in the workforce when services are easily accessible. Additionally, job-specific evaluation and training services, including job and/or ergonomic analysis, must be performed at the work site and therefore are not appropriately reported using other place of service codes (except POS 99, which is nonspecific).

    CMS maintains POS codes used throughout the health care industry. Additional information about POS codes is available on CMS' website. CMS will publish a change request in the near future to inform payers of the change. Meanwhile, the updated list of codes is available here.

    New in the Literature: Screening for Clinically Important Cervical Spine Injury (CMAJ. 2012;184(16):E867-E876.)

    Based on studies with modest methodologic quality and 1 direct comparison, the Canadian C-spine rule appears to have better diagnostic accuracy than the National Emergency X-Radiography Utilization Study (NEXUS) criteria when used to assess the need for cervical spine imaging, say authors of a systematic review published in CMAJ. Future studies need to follow rigorous methodologic procedures to ensure that the findings are as free of bias as possible, they add.

    For this review, the authors identified studies by an electronic search of CINAHL, Embase, and MEDLINE. They included articles that reported on a cohort of patients who experienced blunt trauma and for whom clinically important cervical spine injury detectable by diagnostic imaging was the differential diagnosis, evaluated the diagnostic accuracy of the Canadian C-spine rule or NEXUS or both, and used an adequate reference standard. They assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies criteria. They used the extracted data to calculate sensitivity, specificity, likelihood ratios, and posttest probabilities.

    Fifteen studies of modest methodologic quality were included in the review. For the Canadian C-spine rule, sensitivity ranged from 0.90 to 1.00 and specificity ranged from 0.01 to 0.77. For NEXUS, sensitivity ranged from 0.83 to 1.00 and specificity ranged from 0.02 to 0.46. One study directly compared the accuracy of these 2 rules using the same cohort and found that the Canadian C-spine rule had better accuracy. For both rules, a negative test was more informative for reducing the probability of a clinically important cervical spine injury.

    Life Expectancy Longer for People Who Engage in Leisure-time Physical Activity

    Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to researchers at the National Cancer Institute, part of the National Institutes of Health (NIH).

    In order to determine the number of years of life gained from leisure-time physical activity in adulthood, researchers examined data on more than 650,000 adults, mostly aged 40 and older, who took part in 1 of 6 population-based studies that were designed to evaluate various aspects of cancer risk.

    After accounting for other factors that could affect life expectancy, the researchers found that life expectancy was 3.4 years longer for people who reported they got the recommend level of physical activity (2.5 hours at moderate intensity/1.25 hours at vigorous intensity each week). People who reported leisure-time physical activity at twice the recommended level gained 4.2 years of life.

    The researchers even saw benefit at low levels of activity. For example, people who said they got half of the recommended amount of physical activity still added 1.8 years to their life.

    The researchers found that the association between physical activity and life expectancy was similar between men and women, and blacks gained more years of life expectancy than whites. The relationship between life expectancy and physical activity was stronger among people with a history of cancer or heart disease than among those with no history of cancer or heart disease.

    The researchers also examined how life expectancy changed with the combination of both activity and obesity. Obesity was associated with a shorter life expectancy, but physical activity helped to mitigate some of the harm. People who were obese and inactive had a life expectancy that was between 5 to 7 years shorter (depending on their level of obesity) than people who were normal weight and moderately active.

    The study was published online November 6 in PLoS Medicine.