Hello Jimmie: I've had to do a bit of researching to back up my statements. However, I do NOT find any evidence to support them. Perhaps I spoke to hastily. Although, just because it's not specifically denied, does not mean that it's covered.
I anticipate that socialization is billed using the Community/Work Integration Procedure Code. I've provided copy of our LMRP for Community Integration. See if you can decipher what it's saying. quote> Community/Work Reintegration Training (CPT Code 97537): quote> Community reintegration is performed in conjunction with other quote> therapeutic procedures such as gait training and selfcare/ home quote> management training. quote> The payment for community reintegration training is bundled into quote> the payment for those other services. Therefore, these services quote> are not separately reimbursable by Florida Medicare. My primary concern is with the client and not with the billing, although billing is an issue. I met again with the client to explain that I could not have speech as my primary goal. I explained that we can address speech as part of our therapy as it relates to mobility, socialization, etc. She again denied wanting to address other issues and reiterated that her primary concern is her speech. I advised her that I would try to locate a SLP in the area that might be willing to come to the ALF. One last thing that I want to add. In doing my 'research', I did discover that Florida's Intermediary will cover motivation as follows: quote> When an individual's motivational needs are related to a specific quote> diagnosed psychiatric illness, the meeting of such needs would quote> require an individualized therapeutic program. An occupational quote> therapy program would be considered reasonable and necessary. ===============<Original Message>=============== On 3/22/2005, Jimmie Arceneaux <[EMAIL PROTECTED]> said: JA> Ron, JA> I am reviewing the outpatient OT LMRP for my geographical area JA> and I do not note any wording that states Medicare doesn't pay for JA> "socialization." Could you tell me where you are referencing that JA> statement? Is it something particular to you intermediary in JA> Florida? JA> I would code this case 438.0 late effects of CVA - cognitive JA> deficits, 438.12 late effects CVA - dysphasia, 438.89 other late JA> effects of CVA and possibly either 438.84 ataxia or 438.85 vertigo JA> (both related to late effects CVA) depending on if you will JA> concurrently address the balance issues. The CPT codes utilized JA> would most assuredly be 97532 cognitive skills development, 97530 JA> therapeutic activities, 97537 community reintegration training and JA> possible 97112 neuromuscular re-ed if you work on the balance as JA> well. JA> I don't see any problem with noting a skilled intervention in JA> the scenario you noted and as long as you treat within the scope of JA> OT practice and don't attempt to be a pseudo speech pathologist, you JA> should be able to meet the basic guidelines for covered OT practice. JA> It would depend on what types of intervention you are prepared to JA> provide. Medicare does not reimburse for diversional activities or JA> activities to improve motivation and this is quoted from my LMRP as JA> noted above. JA> Jimmie -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
