Physician referrals -- follow to the letter?

[Guest guest]

When a referral for PT comes from a physician that includes modalities that the

therapist chooses not to use, is there any requirement (state law, Joint

Commission, CMS, or other) that this be addressed in the documentation or with

involvement of the physician?

For example, a prescription for PT treatment of chondromalacia patella specifies

ultrasound and VMO strengthening, and the therapist instead does ankle

mobilization, patellar taping and glute strengthening based on his examination

findings and assessment. Must the MD agree, or can the PT proceed as he sees

fit, reporting the results to the physician in a progress note? (This is in a

hospital-based outpatient setting.)

Thanks for your input.

Leigh , MSPT

San Francisco, CA