Feesoap - Chiro
| |CPT CODE |OFFICE VISIT | FEE | CPT CODE DESCRIPTION |FEE |
| |99201 |New Patient , problem-focused | | |72010 |X-Ray, Spine entire, AP & Lat | |
| |99202 |New Patient, expanded problem | | |72040 |X-Ray, Cervical, AP & Lat | |
| |99203 |New Patient, detailed | | |72070 |X-Ray, Thoracic, AP & Lat | |
| |99204 |New Patient, comprehensive | | |72100 |X-Ray, Lumbar,AP & Lat | |
| |99205 |New Patient, comprehensive 2 | | | | | |
| |99211 |Est. Patient, minimal service | | | | | |
| |99212 |Est. Patient, problem-focused | | | | | |
| |99213 |Est. Patient, expanded problem | | |97010 |Hot or cold packs | |
| |99214 |Est. Patient, detailed | | |97012 |Mechanical traction | |
| |99215 |Est. Patient, comprehensive | | | | | |
| |98940 |CMT, 1-2 areas | | | | | |
| |98941 |CMT, 3-4 areas | | |99070 |Supplements | |
| |98942 |CMT, 5 areas | | | | | |
| |98943 |CMT, extraspinal | | | | | |
|Subjective: |Pain Levels | Aggravations: |
|1)_________________________ |0 1 2 3 4 5 6 7 8 9 10 | |
|2)_________________________ |0 1 2 3 4 5 6 7 8 9 10 | |
|3)_________________________ |0 1 2 3 4 5 6 7 8 9 10 | |
|Objective: | Rotation Flexion Extension Derifield Leg |
| |Check |
|ROM - Cervical |[pic] Normal [pic] R[pic] [pic] R[pic] [pic] L[pic] | [pic] [pic] | [pic] [pic] [pic] |[pic] Short Right |
|ROM - Lumbar |[pic] L[pic] |[pic] [pic] |[pic] |[pic] Short Left |
| |[pic] Normal [pic] R[pic] [pic] R[pic] [pic] L[pic] |[pic] [pic] |[pic] [pic] [pic] | |
| |[pic] L[pic] |[pic] [pic] |[pic] | |
|Assessment: [pic] Progress as Expected [pic] Slower [pic] Faster [pic] Maximum Improvement |
|Improvement made: 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% |
|Comments: |
|TX: Sp Fix Pain R L A P I S | Sp Fix Pain R L A P I S | Sp Fix Pain R L A P I S |
|C1 [pic] [pic] [pic] [pic] [pic] |T1 [pic] [pic] [pic] [pic] [pic] |L1 [pic] [pic] [pic] [pic] [pic] |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |
|C2 [pic] [pic] [pic] [pic] [pic] |T2 [pic] [pic] [pic] [pic] [pic] |L2 [pic] [pic] [pic] [pic] [pic] |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |
|C3 [pic] [pic] [pic] [pic] [pic] |T3 [pic] [pic] [pic] [pic] [pic] |L3 [pic] [pic] [pic] [pic] [pic] |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |
|C4 [pic] [pic] [pic] [pic] [pic] |T4 [pic] [pic] [pic] [pic] [pic] |L4 [pic] [pic] [pic] [pic] [pic] |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |
|C5 [pic] [pic] [pic] [pic] [pic] |T5 [pic] [pic] [pic] [pic] [pic] |L5 [pic] [pic] [pic] [pic] [pic] |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] |
|C6 [pic] [pic] [pic] [pic] [pic] |T6 [pic] [pic] [pic] [pic] [pic] | |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] | |
|C7 [pic] [pic] [pic] [pic] [pic] |T7 [pic] [pic] [pic] [pic] [pic] | |
|[pic] [pic] [pic] [pic] |[pic] [pic] [pic] [pic] | |
| |T8 [pic] [pic] [pic] [pic] [pic] | |
| |[pic] [pic] [pic] [pic] | |
| |T9 [pic] [pic] [pic] [pic] [pic] | |
| |[pic] [pic] [pic] [pic] | |
| |T10 [pic] [pic] [pic] [pic] [pic] [pic]| |
| |[pic] [pic] [pic] | |
| |T11 [pic] [pic] [pic] [pic] [pic] [pic]| |
| |[pic] [pic] [pic] | |
| |T12 [pic] [pic] [pic] [pic] [pic] [pic]| |
| |[pic] [pic] [pic] | |
| | |PELVIS [pic] [pic] [pic] [pic] [pic] [pic] |
| | |[pic] [pic] [pic] |
| | |SACRUM [pic] [pic] [pic] [pic] [pic] [pic] [pic] |
| | |[pic] [pic] |
| | |COCCYX [pic] [pic] [pic] [pic] [pic] [pic] [pic] |
| | |[pic] [pic] |
|Plan: | |
|[pic] Continue with current corrective treatment |[pic] Adjustment [pic] Traction [pic] Moist Heat [pic] Ice [pic] Ultrasound [pic] Diathermy |
|[pic] Change frequency of visits |[pic] Myofascial Release [pic] Electrotherapy [pic] Cervical collar [pic] Lumbar support |
|[pic] Addition to treatment plan | |
|[pic] Remove from treatment plan | |
|[pic] Move from corrective to maintenance care | |
|[pic] Release from care, max improvement | |
|[pic] Discontinue care, patient's choice | |
| |[pic] 1 [pic] 2 [pic] 3 [pic] 4 [pic] 5 [pic] 6 [pic] 7 days/week |
| |For [pic] 1 [pic] 2 [pic] 3 weeks [pic] 1 [pic] 2 [pic] 3 [pic] 4 [pic] 5 [pic]6 |
| |[pic] 6+ months |
| |[pic] PRN |
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