Hello Chuck: I won't disagree that using the word 'function' is very important for payment. But, that is exactly why it's is a buzz word. However, even CMS definition uses function in a variety of formats. They refer to function as ".. restore functions which have been impaired by illness, injury...", "patient's level of function", "... therapeutic activities designed to restore physical function", and finally "... a stroke patient with functional loss resulting in a distorted body image."
To me, all of these examples simply point to the fact that we are doing some sort of intervention to make a difference in either a body part, body function or in some case a person's function. Again, to me this is what most medically necessary treatments are designed to do. So, there is nothing special nor unique in associating occupational therapy with function. Heck, even the PT definition says: "maintain level of function". When I talk with potential referral sources, telling them that I am about function improvements doesn't really tell them anything. However, telling them that I am about occupational improvement give me much opportunity to explain occupation. And, while the word occupation isn't contained in any CPT code, the concept of enabling engagement in occupation as both a therapeutic treatment and an outcome certainly are. Specifically, we can bill medicare as follows: 1. 97535 Self-care management training 2. 97537 Community/work reintegration As I said, while the above two CPT codes don't include the word occupation, occupational therapy certainly strives to improve the areas of self-care and community reintegration On a different note, thank you for giving both the CMS link and definition excerpt. I must say that I am in complete disagreement with much of what CMS' OT definition. For one, I would never have someone doing some arbitrary bilateral sanding in order to increase ROM. I have done and seen many OT's doing such things, including pegs, cones, folding clothes, craft activities, in order to address ROM, strength endurance, etc. I now consider these to be inappropriate for many situation and would only ask someone to do woodworking if that was a missing occupation in their life that had been effected by some disease or illness. Like wise, with folding clothes. To me, it seems inappropriate to have clients folding clothes to improve ROM. They should be folding clothes because that's what they want/need to do and because of some limitation, they can't. Likewise, they should be doing sanding, not because it's good for their ROM, but because it's good for their being (that is their sense of being and belonging). I know that if I were a case manager and my understanding is that OT was going to have my clients doing craft activities or sanding projects to improve their ROM, I would be very hesitant to send them patients. The original concepts of using craft activities was not because it improved people's physical functioning. Instead, engagement in meaningful activity was originally deemed important because through occupation, we are able to find our place in the world and somehow to make sense of being whole. ============================================= On 8/7/2003,[EMAIL PROTECTED] wrote: CW> I don't think "function" is the latest buzzword, but rather it is a CW> term that is very important to payment. For example, Chapter 2 - CW> Coverage of Services of the Outpatient Physical Therapy CW> Comprehensive Outpatient Rehabilitation Facility and Community CW> Mental Health Center Manual uses the term in reference to physical CW> therapy and occupational therapy services. CW> (see: http://cms.hhs.gov/manuals/09_opt/op202.asp#_1_99) Rev. 1/ CW> 04-98/ page 2-57 253. SPECIFIC CORF SERVICES CW> 253.2 Physical Therapy Services.--The coverage guidelines in �271 CW> apply to physical therapy services provided by CORFs. Under those CW> guidelines, maintenance physical therapy, i.e., repetitive services CW> required to maintain a level of functioning, is not covered. CW> However, the establishment of a maintenance program for a patient CW> whose restoration potential has been reached is a covered service. CW> The program may include examinations, evaluations of the patient's CW> condition, preparation of the maintenance program, and the training CW> of nonskilled individuals to carry out the program. CW> 253.3 Occupational Therapy Services.-- A. Definition.--Occupational CW> therapy is medically prescribed treatment to improve or restore CW> functions which have been impaired by illness or injury or, when CW> function has been permanently lost or reduced by illness or injury, CW> to improve the individual's ability to perform those tasks required CW> for independent functioning. Such therapy may involve: CW> The evaluation and reevaluation (as required) of a patient's level CW> of function by administering diagnostic and prognostic tests; The CW> selection and teaching of task-oriented therapeutic activities CW> designed to restore physical function, e.g., use of woodworking CW> activities on an inclined table to restore shoulder, elbow, and CW> wrist range of motion lost as a result of burns; The planning, CW> implementation, and supervision of individualized therapeutic CW> activity programs as part of an overall active treatment program for CW> a patient with a diagnosed psychiatric illness, e.g., the use of CW> sewing activities which require following a pattern to reduce CW> confusion and restore reality orientation in a schizophrenic CW> patient; The planning and implementation of therapeutic tasks and CW> activities to restore sensory- integrative function, e.g., providing CW> motor and tactile activities to increase sensory input and improve CW> response for a stroke patient with functional loss resulting in a CW> distorted body image; CW> I think that is important that when defining OT for external CW> audiances that the language used should somewhat match language in CW> payment systems. The definition of OT in state practice acts should CW> have some parallels to the services that will be paid for under CW> Medicare, for example. This is one reason for the redefinition of CW> "physical therapy"...to align defintions (legally defined scope of CW> practice) with what payers will pay for. >>>> [EMAIL PROTECTED] 08/07/03 08:36AM >>> CW> Hello Jimmie: CW> My earlier post was intended to push the boundaries. The reason is CW> because the term 'function' is very vague. And what is function to CW> you may not be function to me. Or what is function to a PT may not CW> be function. Function is the latest buzz word but in my opinion it CW> is not a word that OT's should encompass. CW> Ron CW> ============================================= CW> On 8/1/2003,[EMAIL PROTECTED] wrote: JA>> Ron, Some would say too much to say! I believe your assessment CW> might JA>> be pushing the boundaries a bit. While the modalities employed CW> by JA>> the PT have purpose and thereby a function, I was referring CW> to JA>> functional activity as it relates to the client. Function to CW> me JA>> entails an engagement aspect as well as a goal which is CW> purposeful. JA>> TENS does not require engagement of the client due to its CW> passive JA>> nature. Isometric exercises while requiring the engagement of CW> the JA>> individual, have limited purpose and goal direction. I did like CW> your JA>> statement about perception as it relates to meaning and relevance. JA>> Jimmie JA>> -----Original Message----- From: Ron CW> Carson JA>> [mailto:[EMAIL PROTECTED] Sent: Thursday, July 31, 2003 7:38 CW> PM JA>> To: Jimmie Arcenaux Subject: Re: [OTlist] what is OT? JA>> Hello Jimmie: JA>> I tend to disagree with your statement that: "A functional CW> activity JA>> by its definition has meaning and relevance to the CW> individual's JA>> life" Well, maybe I don't disagree 100% with the statement but CW> from JA>> a therapeutic perspective, I will disagree. Here's an example. JA>> My wife recently began seeing PT for what was diagnosed CW> as JA>> degenerative disk disease. The PT has evaluated her and CW> began JA>> treating with the following modalities: hot/cold, cervical CW> traction, JA>> TENS, isometric stretches and massage. All of these are CW> functional JA>> activities in the sense that each modality has a function. CW> However, JA>> these activities may have little meaning and relevance to my CW> wife's JA>> life. Yes, they may be improving her spinal function but are CW> the JA>> activities full of meaning and relevance. Probably not, but in CW> truth JA>> only she can answer that question. JA>> And I think that points to one of the biggest differences CW> between JA>> function and meaning. Something's function is what you see on CW> the JA>> outside, however, something's meaning is what one experiences on CW> the JA>> inside. There is almost no way that you can look someone engaging CW> in JA>> an activity, regardless of its function, and understand CW> the JA>> activities meaning and relevance to the client. Only the CW> client JA>> experiences the meaning so only the client can fully express CW> the JA>> meaning. JA>> Almost everything in which a person engages or experiences has CW> a JA>> function. But of that in which we engage, how much has true CW> meaning JA>> and relevance? JA>> I guess the debate begs the question, what is the difference CW> between JA>> function and occupation. For my opinion on this question , I CW> point JA>> you to the following CW> link: JA>> www.otnow.com/newsletter/current_newsletter.htm JA>> Thanks for the interesting debate, JA>> Ron JA>> P.S. My wife says that male OT's always have a lot to say!!! :-) JA>> ============================================= JA>> On 7/30/2003,[EMAIL PROTECTED] wrote: JA>>> Biraj, JA>>> Are you implying that "activities which an individual needs to CW> do JA>>> or is expected to do" are not functional? I agree that CW> occupation JA>>> is a broader concept, but I believe what is occupational is CW> also JA>>> functional. JA>> Occupation JA>>> to me is the work of living as a human being. A functional CW> activity by JA>> its JA>>> definition has meaning and relevance to the individual's life. JA>>> Thanks Brian for the reference to the roots of OT. I could CW> not JA>>> agree JA>> with JA>>> you more. JA>>> Jimmie JA>>> -----Original Message----- From: CW> Incandescent JA>>> [mailto:[EMAIL PROTECTED] Sent: Wednesday, July 30, 2003 CW> 9:04 JA>>> AM To: [EMAIL PROTECTED] Subject: Re: [OTlist] what is OT? JA>>> Hi Jimmie: JA>>> Not to put too fine a point on this but my sense is that CW> when JA>>> viewed JA>> from JA>>> the JA>>> perspective of activities "Occupational" is a distinct and larger JA>> concept JA>>> than JA>>> "functional". The former also includes within it what is CW> meaningful to JA>> the JA>>> individual, whereas "functional" as the word implies refers to CW> those JA>> aspects JA>>> of JA>>> activities which an individual needs to do or is expected to do - CW> thus JA>>> functional. JA>>> What do others think? JA>>> Biraj JA>>> Jimmie Arcenaux wrote: >>>> I believe also that the use of occupational or "functional" (I CW> hate >>>> using that term because it is coined well too often by CW> OTs) >>>> activities as the primary treatment modality is a hallmark CW> of >>>> occupational therapy. It is what the professions history is CW> based >>>> upon. Jimmie JA>>> *****************************��********************************** JA>>> To remove yourself from the OTnow mail list, send a message to: JA>>> [EMAIL PROTECTED] JA>>> In the message's *body*, put the following text: JA>>> unsubscribe OTlist JA>>> - JA>>> List messages are archived at: JA>>> http://www.mail-archive.com/[EMAIL PROTECTED] CW> *****************************��*********************************** JA>>> *****************************��********************************** JA>>> To remove yourself from the OTnow mail list, send a message to: JA>>> [EMAIL PROTECTED] JA>>> In the message's *body*, put the following text: JA>>> unsubscribe OTlist JA>>> - JA>>> List messages are archived at: JA>>> http://www.mail-archive.com/[EMAIL PROTECTED] CW> *****************************��*********************************** JA>> *****************************��********************************** JA>> To remove yourself from the OTnow mail list, send a message to: JA>> [EMAIL PROTECTED] JA>> In the message's *body*, put the following text: JA>> unsubscribe OTlist JA>> - JA>> List messages are archived at: JA>> http://www.mail-archive.com/[EMAIL PROTECTED] JA>> *****************************��*********************************** JA>> *****************************��********************************** JA>> To remove yourself from the OTnow mail list, send a message to: JA>> [EMAIL PROTECTED] JA>> In the message's *body*, put the following text: JA>> unsubscribe OTlist JA>> - JA>> List messages are archived at: JA>> http://www.mail-archive.com/[EMAIL PROTECTED] JA>> *****************************��*********************************** CW> *****************************��********************************** CW> To remove yourself from the OTnow mail list, send a message to: CW> [EMAIL PROTECTED] CW> In the message's *body*, put the following text: CW> unsubscribe OTlist CW> - CW> List messages are archived at: CW> http://www.mail-archive.com/[EMAIL PROTECTED] CW> *****************************��*********************************** CW> *****************************��********************************** CW> To remove yourself from the OTnow mail list, send a message to: CW> [EMAIL PROTECTED] CW> In the message's *body*, put the following text: CW> unsubscribe OTlist CW> - CW> List messages are archived at: CW> http://www.mail-archive.com/[EMAIL PROTECTED] CW> *****************************��*********************************** *****************************��********************************** To remove yourself from the OTnow mail list, send a message to: [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist - List messages are archived at: http://www.mail-archive.com/[EMAIL PROTECTED] *****************************��***********************************
