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RSNAT (repetitive scheduled non-emergent ambulance transportation) glossary tool

The following is a list of common terms used by the medical review department for prior authorization requests. This list provides a definition and/or criteria to assist with the documentation requirements for each term. 

Example: If documentation states “ADL assist level TD,” we expect the documentation submitted to describe (paint the picture) that the patient required 100% assistance with ADL. 

Activities of daily living (ADL)

ADLs are activities related to personal care. They include bathing or showering, dressing, getting in and out of bed or a chair, walking, personal hygiene, and eating.

ADL Assist Level Criterion
Total dependence (TD) Requires 100% of assistance with ADLs
Maximum assist with ADLs Requires 75% or more assistance with ADLs
Moderate assist with ADLs Requires 50% - 75% assistance with ADLs
Minimal assist with ADLs Requires 50% or less assistance with ADLs
Not applicable No assessment included in documentation

Bed-confined

A beneficiary is bed-confined if he/she is: 

  • Unable to get up from bed without assistance;
  • Unable to ambulate; and
  • Unable to sit in a chair or wheelchair. 

The term "bed-confined" is not synonymous with "bed rest" or "non-ambulatory".

Muscle strength scale

Muscle strength is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. The grade, description, and criteria below may be used interchangeably depending on what is included in the medical documentation. 

Grade Description Criterion
0 No activity No activity
1 Trace activity No visible movement with small contractions
2 Poor Able to complete movement with gravity removed (25%)
3 Fair Can complete movement against gravity, but not when pressure is applied (50%)
4 Good Full range of motion with moderate pressure applied (75%)
5 Normal Can withstand added pressure (100%)
Not applicable N/A No muscle strength assessed in the medical documentation

Upper body trunk control -- static sitting 

Muscle strength is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. The grade, description and criterion below may be used interchangeably depending on what is included in the medical documentation.

table> Grade Description Criterion 0 Poor Beneficiary falls or can only maintain upright sitting with double arm support 1 Fair Beneficiary can only maintain upright sitting with single arm support for 10 seconds 2 Good Can maintain upright sitting with arm support for 10 seconds

Upper body trunk control -- dynamic sitting

Beneficiary is instructed to lean forward with a fixed trunk for approximately 45° and return to starting position, also referred to as dynamic posture, or sitting balance.

Grade Description Criterion
0 Poor/fair Unable to complete; cannot reach target position
1 Good Able to complete; lean forward and maintain position

Hemiplegia/hemiparesis

Paralysis of one side of the body; please refer to strength scale for assistance. 

Paralysis 

Loss of purposeful movement, usually because of neurological disease (such as strokes, spinal cord injuries, poliomyelitis), drugs, or toxins.

Quadriplegia

Paralysis of all four limbs; also known as tetraplegia.

Below the knee amputation (BKA)

Amputation that involves removing the foot, ankle joint, distal tibia, and fibula with related soft tissue structures; often represented by “BKA”; does not always impair muscle strength.

Above the knee amputation (AKA)

Amputation that involves removing the leg from the body by cutting through both the thigh tissue and femoral bone; often represented by “AKA”; does not always impair muscle strength.

Bilateral upper extremity (BUE)

Arms; may be represented individually as: right upper extremity (RUE) and left upper extremity (LUE); often represented by acronym only. 

Bilateral lower extremity (BLE)

Legs; may be represented individually as: right lower extremity (RLE) and left lower extremity (LLE); often represented by acronym only.

Contractures

Fibrosis of connective tissue in skin, fascia, muscle, or a joint capsule that prevents normal mobility of the related tissue or joint.

Cognition deficits

Includes disorientation, suicidal ideations, attempts, and gestures, homicidal behaviors, hallucinations, violent or disruptive behavior, signs/ symptoms of delirium tremens, drug withdrawal signs/symptoms, severe anxiety, acute episode, or exacerbation of paranoia; can also be referred to as “altered mental status.”

Negative pressure wound therapy

Also referred to as having a wound vac (vacuum assisted closure); negative pressure wound therapy (NPWT) aims to optimize the physiology involved in wound healing by applying sub-atmospheric pressure to help reduce inflammatory exudate and promote granulation tissue. It is primarily utilized to treat complex wounds which are non-healing or at risk of non-healing, such as diabetic foot ulcers or skin grafts.

Pressure ulcer

Damage to the skin or underlying structures from compression of tissue and inadequate perfusion. Also referred to as decubitus ulcers, and/or bedsores. Often represented by various stages.

Stage Description
I A pressure-related change to intact skin, including change in skin temperature, tissue consistency, or sensation; lesion presents as well circumscribed, non-blanchable erythema
II Partial-thickness skin loss involving epidermis and/or dermis; ulcer is superficial and appears as an abrasion, blister, or shallow crater
III Full-thickness skin loss involving subcutaneous tissue damage or necrosis that may extend down to, but not through, underlying fascia; ulcer appears as a deep crate with or without undermining of adjacent tissue
IV Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structure; undermining and sinus tracts may also be associated with stage IV ulcers
Unstageable Full-thickness pressure injuries in which the base is obscured by slough and/or eschar

Cardiac monitoring

Cardiovascular monitoring services are diagnostic medical procedures using in-person and remote technology to assess cardiovascular rhythm (ECG) data; a medical attendant is required to monitor these devices.

Intravenous infusion (IV)

A therapeutic, prophylactic, or diagnostic administration of substances or drugs via intravenous route; a medical attendant is required to monitor fluids that are actively being infused.

Airway management

Refers to the management and monitoring of tracheostomies requiring ventilation and/or deep suctioning, continuous BiPap and oxygen that is unable to be administered by beneficiary.

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