Fellow OTs:
   
  I believe an OT evaluating and treating dysphagia can be more beneficial that 
a SLP, particulary in the long term care setting.  I believe we have  better 
wholistic training to treat in the area of swallowing difficulties.  We 
consider more during our treatments than SLP, such as vision, spatial 
relations, bilateral integration, effects of the enviroment, sitting 
balance/posture, overall endurance (not just oral motor), cervical ROM/strength 
and UE strength/ROM/sensation and there is more.  
   
  From a management perspective it can be very benefical for a OT eval and 
treat for dysphagia.  SLPs are difficult to find and are not always full-time 
emoployees; so you have to call them in at a higher per-diem rate and they 
might just do a screen, which is not billable.  Once again, it depends on your 
programming and staffing patterns.  Also, under Medicare part B, SLP claims are 
reviewed at a much higher rate, so there is a greater potential for denials.
   
  What I have stated above is coming from treating dysphagia in a long term 
care setting.  SLPs can have a very beneficial role in this setting for 
dysphagia, cognition and also in other settings.  In general, I have found that 
it comes down to how comfortable and the amount of  training an OT has in 
dysphagia.
   
  Personally, I am a huge advocate for OTs to eval and treat for dypshagia.  I 
have done it for the last 5 years.  The company I was previously working for 
had a policy that every OT must receive training in dysphagia.  
   
  I have now moved onto a more non-traditional OT role in operating a division 
of medical supply company; where I perform management, sales and OT duties for 
custom seating devices and orthotics.  Please feel free to comment on 
non-traditional roles using our OT training.  I see more and more of these 
because of the value and skills we can bring to an organization.
   
  Please feel free to comment in an open forum or personally, I have a alot of 
positive views and suggestions as to how to make OTs treating dysphagia work 
and non-traditional settings.
   
  Have a great Holiday!!
   
  Gregory M. Stelmach, OTR/L
  Director of Operations
  Centralized Medical Equipment
  50 Kerry Place
  Norwood, MA
  781-953-0175
  www.CentralizedMedicalEquipment.com
   
   
  

Jim Arceneaux <[EMAIL PROTECTED]> wrote:
  Hello,
Per Medicare guidelines speech therapists are not allowed to bill using the 
e-stim cpt codes. Their only option for billing vital stim would be to use the 
swallowing treatment code. This code is untimed, meaning they can only bill it 
once per visit. Not very lucrative.
Jimmie

Orli Weisser-Pike wrote:
Our ST does Vital Stim and bills Medicare. None of the OTs that I know work 
directly with swallowing issues. The inpatient rehab unit has a "diners" group 
at each meal supervised by either OTs or STs--making sure that the patients get 
their meals thickened, use correct feeding strategies, etc. 


---Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Behalf Of Jim Arceneaux
Sent: Wednesday, November 29, 2006 9:34 PM
To: OTlist
Subject: [OTlist] Swallowing


Hello,

Is anyone out there working with swallowing patients? It seems to be a dead 
issue for OT at most sites, but at my work there has been some talk about Vital 
Stim and the inability for ST to bill for this modality under a Medicare 
situation. Just curious.

Jim


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