What Services Are Considered Medically Necessary For Pediatric Occupational Therapy

Baronial 21, 2018

Documenting the Medical Necessity of Therapy Services

Medical review denials for concrete therapy (PT) and occupational therapy (OT) services are often fabricated due to lack of documentation of medical necessity.  All services billed to Medicare must run across the criteria of "medically necessary and reasonable." To determine whether a service is reasonable and necessary, the Medicare habitation health benefit considers each beneficiary'due south unique medical condition. The medical record documentation provides the basis for this determination. Coverage decisions are always based upon the objective clinical evidence of the beneficiary'southward individual need for intendance.

Information technology is the home wellness bureau's responsibility to provide articulate documentation of the medical necessity and reasonableness. This includes: progress or lack of progress, medical status, functional losses, and measurable short and long treatment goals.

Physical Therapy
Physical therapy tin exist vital in rehabilitating a beneficiary after a modify in condition, and increasing the beneficiary'due south abilities dorsum to a functional status in the home. The services are provided with the expectation, based on the assessment made by the physician of the casher's rehabilitation potential, that the condition will improve materially*in a reasonable and predictable period of time, or the service is necessary to establish a safe and constructive maintenance program. A Local Coverage Determination for physical therapy servicesis available to aid providers in determining appropriateness of physical therapy services, based on the casher's functional condition

Follow these two principal guidelines to demonstrate that therapy services are reasonable and medically necessary.

1. Document the complexity of the treatment
   • Any tests, measures, assessment
   • Planning, interventions, changes
   • Teaching and cess of patient's ability to follow through
   • Connected need for assessment and didactics – show the aid provided, the cess, the programme for changes, and other interventions
     • Example: When assessing gait, rather than just "ambulated 10 feet," it would be more consummate to land: "Patient continues to push FWW several feet in front, without a footstep-through gait. Patient began to lose residue, caught by this physical therapist. Voice commands provided to pace through and into walker, and patient able to ambulate 10ft with this aid."
   • Avert documenting repetitive modalities and interventions
2. Document why treatment is medically advisable, based on beneficiary'southward condition
   • Patient'due south needs, functional changes or changes in condition
   • Prior level of function
   • Document whatever other conditions that may back up need for therapy in situations that wouldn't normally need a therapist
   • Example: A patient needs ongoing range of movement on left leg. Often a home health aide or family unit fellow member could provide this after being taught. This patient needs the therapist to practice the range of motion because they accept a not-healing fracture.

Occupational Therapy
Visits by an occupational therapist to assess and reassess a beneficiary'due south rehabilitation needs and potential, or to develop and/or implement an occupational therapy program, are covered when reasonable and necessary because of the beneficiary'due south condition. Information technology should be clear in the documentation that the occupational therapist is working on functional limitations and tasks with the beneficiary.

Follow these two principal guidelines to demonstrate that occupational therapy services are reasonable and medically necessary.

1. Document the complication of the treatment
   • Any tests, measures, assessment
   • Planning, interventions, changes
   • Teaching and assessment of patient'due south power to follow through
   • Continued demand for cess and teaching – show the aid provided, the assessment, the plan for changes, and other interventions
   • Avoid documenting repetitive modalities and interventions
2. Document why treatment is medically appropriate, based on beneficiary's condition
   • Patient'due south needs, functional changes or changes in condition
   • Prior level of function
   • Document any other conditions that may back up need for therapy in situations that wouldn't ordinarily demand a therapist

Resources:

• Medicare Benefit Policy Manual, Pub 100-02, Ch. 7 Section 40.2.one - General Principles Governing Reasonable and Necessary Concrete Therapy, Speech-Linguistic communication Pathology Services, and Occupational Therapy

*--The term "materially" means having existent importance to consequences, to an important degree, or the comeback tin be perceived in material class (considerately). In general, in that location should exist a reasonable expectation that appreciable comeback in the overall safety of functional ability volition occur.

What Services Are Considered Medically Necessary For Pediatric Occupational Therapy,

Source: https://www.cgsmedicare.com/hhh/pubs/news/2018/0818/cope8794.html

Posted by: henryresprommed.blogspot.com

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