Sue, I wasn't implying that the PT could or couldn't provide the service. My thought was relative to access. Obviously if the PT was to provide this service in the proferred scenario, the OT would be required to modify intervention so that duplication does not occur. I argue though that PT might address this issue only as part of the base and biomechanical task of walking. OT, at least should be intervening in terms of the big picture - occupation. To clarify though, if one peruses the Medicare regulations which allowed OT to work with low vision patients, they would find that the same regulation states that a PT also can provide like services This is based on reimbursement and not whom would be the better provider. Regarding your scenario of the hand surgery patient: I assume, since you state the PT recently discharged, that the patient is already on caseload. OT can recertify and follow an already opened case without other disciplines involved. If this is a new episode, and acute surgery, why can't nursing provide wound care instruction/services or s/s infection, etc? Jim
Sue Hossack <[EMAIL PROTECTED]> wrote: Thanks for the responses, they have been very helpful. I have been perusing the online manuals on the CMS page for some time but it is difficult to interpret!. I would like to respond to Jim w.r.t. the visual field-cut patient - providing strategies for mobility safety was one of *my* goals - I trained the patient in tracking techniques to overcome the visual-field cut - (he made very good progress) both for functional mobility and for close work such as reading/writing. How could a PT do that as well (without duplication of effort)? In that particular instance the patient had some long-standing knee problems so the PT used that for his skilled visit, but it wasn't really as a result of the minor occipital CVA the pt had had. It seems to be the case that the pt has to have a physical problem that a PT can address before an OT can be utilized. (these patients are usually therapy-only patients). If it is really the correct interpretation I guess the PT can find something for one visit, but it seems strange. I know we are getting a patient next week who has had hand surgery, we have worked with her before and the PT had done all he can with her. I will be working with her hand (looking forward to it) but we are wondering what the PT can document as skilled when he has already documented goals met very recently? I am realising there is more to this that just OT's not being able to start a patient, although we can d/c, recert and resume. Terrianne mentioned that her agency does that to avoid looking like they were using the PT order just to open OT, but surely that is what is happening? A pt can be PT-only, or Speech-only, or nursing-only, but cannot be OT-only unless another discipline is involved initially. And so you have to get a PT (or SLP/RN) to open the patient and do skilled visits before the OT can be stand-alone. Very frustrating! I should point out in all of the cases I have worked with we had both PT and OT orders initially from the referring agency, it was not a case of only PT orders, then the PT did the SOC and ordered OT. (if that is clear!) Sue, > They are correct in their interpretation. Check with those PT's and make sure > they can't >provide some service they may have missed (i.e. the pt. with a > visual field cut, providing some >strtegies to improve mobility safety.) > Check to see if the patient might benefit from education >from nursing r/t > diagnosis and/or medications. > > JIm Terrianne Jones wrote: Hi Sue, that is the way my agency does it as well, and I was told that the reason PT needed to go back out at least once was to avoid looking like we were using the PT order just to open OT. Terrianne -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************************** --------------------------------- Be a better Globetrotter. Get better travel answers from someone who knows. Yahoo! Answers - Check it out. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
