Bilan diagnostic kiné : état des lieux

Bilan diagnostic kiné : état des lieux

Il est obligatoire pour tout traitement thérapeutique afin d’établir le diagnostic du patient, mesurer son évolution et assurer la liaison avec le médecin prescripteur. Suite aux décrets et autres modifications règlementaires ayant eu lieu ces dernières années autour des bilans, voici les points importants à savoir : la réglementation en vigueur, le rôle de cet acte bilan diagnostic kiné : tout savoirdans le parcours de soins et la méthode de réalisation.

Bilans associés

1 – Le bilan diagnostic kiné : une obligation conventionnelle médico-légale

Le Bilan Diagnostic Kinésithérapique a été introduit par le Décret n°96-879 du 8 octobre 1996relatif aux actes professionnels et à l’exercice de la profession de masseur-kinésithérapeute puis a été repris dans la Nomenclature Générale des Actes Professionnels (NGAP) le 4 octobre 2000. Il est obligatoire d’établir une fiche synthétique du bilan initial, intermédiaire et final le cas échéant. Les éléments relatifs au bilan initial doivent être tenus à la disposition du contrôle médical. A tout moment, notamment au vu de la fiche synthétique, le médecin prescripteur peut demander une modification du protocole thérapeutique ou interrompre le traitement.

Extrait du texte de 1996 et modifié ensuite par des décrets successifs (2000, 2009) 

Ce que nous pouvons retenir des dernières modifications de l’article[1] est que le « bilan est tenu à disposition », mais le MK a l’obligation d’envoyer un fiche de synthèse dans les cas suivants :

  • A l’issue de la dernière séance lorsque le traitement a comporté un nombre de séances égal ou supérieur à dix.
  • lorsqu’il est nécessaire de modifier le traitement initial prévu
  • Lorsqu’il apparaît une complication pendant le traitement

Le bilan est honoré, c’est-à-dire qu’il peut être facturé et qu’il est pris en charge par les organismes de la Sécurité Sociale au même titre que les actes. La rémunération de ce bilan se côte AMS 8,1 (soit 17,41 euros) pour les traitements entre 10 et 20 séances de rééducation fonctionnelle inscrits à la NGAP, puis de nouveau la même cotation toutes les 20 séances. Exception pour les traitements des conséquences des affections neurologiques et musculaires, en dehors des atteintes périphériques : le bilan se côte alors AMK 10,1 (soit 21,72 euros) pour les traitements entre 10 et 50 séances, puis de nouveau la même cotation toutes les 50 séances.
La cotation en AMS, AMK ou AMC du bilan est forfaitaire et ne peut être appliquée que pour un nombre de séances égal ou supérieur à 10.

2 – Le rôle du BDK

Le médecin a pour rôle d’établir le diagnostic médical qui est l’identification d’une pathologie. A partir de ce diagnostic, le kinésithérapeute va mettre en place un traitement thérapeutique adapté à chaque cas et communiquer au médecin l’évolution du patient. Le bilan du patient devra être réalisé à différents stades du traitement : bilan initial, intermédiaire et final.

Selon la NGAP : « Ces évaluations permettent d’établir un diagnostic kinésithérapique et de choisir les actes et les techniques les plus appropriés. »

Le bilan a pour but d’évaluer le patient en 3 axes : ses incapacités (partie fonctionnelle), ses déficiences (partie structurelle) et son handicap (répercussions sociales)[1].

Exemple : une fracture de la cheville (déficience) rend impossible la marche (incapacité), ce qui oblige la personne à interrompre momentanément son activité professionnelle (handicap).

3 – Méthode de réalisation du BDK

Evaluation des déficiences :
Analyse des déformations et des degrés de liberté articulaire, évaluation de la force musculaire, de la sensibilité, de la douleur…).

  • Douleur objectivée par des échelles : Echelle Visuelle Analogique (EVA), Echelle Verbale Simplifiée (EVS), EVN…
  • Déficits articulaires exprimés en degrés d’angle. (bilans articulaires)
  • Déficits musculaires coté de 0 à 5 (bilans musculaires)

Les Incapacités :
C’est le bilan fonctionnel de la personne. Il évalue des aptitudes gestuelles, possibilité ou non de réaliser les gestes de la vie courante et de la vie professionnelle….Il doit être le plus précis possible et chiffré. C’est lui qui va permettre de mettre en évidence les résultats du traitement. Il est fortement recommandé d’utiliser des bilans d’incapacité validés et comportant un score.

C’est La Haute Autorité de Santé qui valide les tests et les bilans, il est possible de les trouver sur leur site : Quick Dash, Get Up And Go, Echelles Visuelles,…

Les Handicaps :
Répertorier les répercussions sociales des incapacités comme, par exemple, l’interruption des activités professionnelles, des activités de loisirs… Des bilans de qualité de vie sont également disponibles sur le site de l’HAS.

Différence entre le bilan et la fiche de synthèse
La Fiche de Synthèse est décrite par la NGAP comme un « lien écrit avec le prescripteur ».
La confusion est souvent faite entre la Fiche de Bilan (reste dans le dossier MK) et la Fiche de Synthèse (envoi au prescripteur).

Pourquoi faut-il faire les BDMK ?

Certains organismes et médecins déplorent la non-réalisation des bilans dans des situations pourtant soumis à la réglementation. Il est nécessaire de rappeler que la réalisation du BDK n’est pas juste une règle contraignante qui protège en cas de contrôle de la Caisse. C’est surtout un acte qui améliore la prise en charge du patient et permet une valorisation du métier auprès des autres professions médicales.

Un kinésithérapeute explique par ces mots : « Comment voulez-vous quantifier les progrès d’un patient si dès le départ nous ne savons où il en est ?[…] le bilan permet d’avoir un raisonnement clinique adapté car pour une même pathologie, plusieurs techniques sont envisageables. »

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