Ron Long reflection and musing on the current discussion. Some time ago in the Canadian journal there was an article about the relative strengths and weaknesses of the approachs to OT.practice in Canada and the US. The conclusion as I remember it was that the funding methods produced quite different emphasis. US therapists are forced to justify all their actions and we can learn from that. We are much freer to focus on the client. My comments on the gardening issue came from the Canadian perspective. Reflecting on that and with the recently posted 6 year olds definition in mind lets look at the flower planting again. During the discussion it became apparent that pain/endurance were probably the barriers the client perceived. It seems that she managed them well enough to perform her basic ADLs but was pain an issue in them as well? Is there a benefit in addressing pain management/ energy conservation for all her occupations? Did she resist focussing on the basic ADLs because they are something she has to do as opposed to wants to do (COPM). Traditionally we have used activities as our intervention and treatment modality. The more meaningful and valued the activity the more investment by the client. I think this is what Jimmie is talking about when he says it depends on how you document. Is the leisure activity the goal or the treatment modality for pain management / energy conservation as components of all the necessary occupations? Wouldn't this be addressing occupation, Ron? And allow one to use the bundled CPT codes in good conscience? You are facing a bureaucratic, hairsplitting funding system based on the old medical mind/body split. It forces you to really think about what you are doing and develop well articulated goals to justify payment. I know that the original question was about eligibility for payment but the discussion has raised philosophic questions as well. The comment from the Medicare advisor that they don't pay for everything that an OT can do seems to be on the mark and fair enough. We have to realise that the CPT codes are not based on our philosophy. Claudia Allen has addressed and lobbied for codes that are applicable to cognitive deficit which is why the percentage of assistance needed at each level can be documented, but that is a discussion for another day. Joan Riches
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