Chest Physiotherapy (follow-up session)

What it is

The lungs clear themselves by moving a thin layer of mucus upward until it can be coughed out. When that mucus is too thick, too plentiful, or the cough is too weak, it settles in the smaller airways and stays there. Chest wall manipulation attacks that mechanically. The person is positioned so that the segment of lung being treated points downward and gravity works in the right direction. A therapist, nurse, or trained family member then cups a hand and claps rhythmically over that part of the chest or back — the sound should be hollow, not a slap — and follows with vibration, a flat hand shaking the ribs during the out-breath. Each area gets several minutes, after which the patient takes a deep breath and coughs. This listing is the subsequent session rather than the first: the introduction has happened, and what is billed here is continuing the treatment and evaluating how it is going.

Why it is done

• To clear retained secretions in conditions where mucus accumulates faster than it can be cleared, such as cystic fibrosis and bronchiectasis
• To help a person with a weak cough — from neuromuscular disease, pain after surgery, or general debility — get mucus out of the lungs
• To open up areas of lung that have collapsed because an airway is plugged
• To check that a patient or family member is performing the technique correctly at home, and to adjust which areas are being treated

What to expect

A session is done lying on a bed or table, with pillows or a wedge used to tilt the body into a series of positions; some of those put the head lower than the chest. Clapping over each area runs several minutes, and a session covers whichever areas the provider has specified, so the whole thing commonly takes a half hour or so. It should not hurt — clapping hard enough to sting is doing it wrong. Coughing and bringing up phlegm afterward is the point of the exercise, not a side effect. Sessions are often repeated daily or more, and much of the treatment eventually moves home, which is why the family member's technique is part of what is being assessed.

Questions worth asking

• Is this billed per session, and how many sessions are planned before the treatment moves home?
• Does the first session bill differently from the follow-up ones, and which one is on my statement?
• If a mechanical vest or other airway-clearance device would replace hands-on sessions, what is the device cost against the running cost of visits?
• When this is done during a hospital stay, is it inside the daily room rate or added as a separate therapy charge?
• If a family member is being trained rather than the patient treated, is that visit still charged at the same rate?