This is all very interesting to me. I was warned that Medicare (prob most insurance) needs to see medical terminology and goals in notes or they will just deny because most outside our profession do not understand the therapeutic benefit of everyday interventions beyond the typical obvious ADL's of dressing, toileting, bathing etc. For instance
1. "folding towels" would be "activity designed to increase bilateral coordination, sequencing and problem solving skills" 2. "pennies in theraputty" would be "activity designed to increase fine motor strength, pip/dip flexion/extension etc etc" 3. "crossword puzzles" would be "cognitive training activities" The wonderful thing in OT is that we can really do almost anything we want and make it therapeutic. What you did Ron was obviously therapeutic but under appreciated in the medical community. I would think that if I ever ran into that situation, I would just either not put it in the note at all (because I am assuming that she had other goals that you worked on) and do exactly what you did or reword it so that there would be no question that services were necessary. Hmmm.... Such as "Pt participated in familiar fine motor activities to increase cognitive processing skills, facilitate long-term memory, and increase social occupation skills." "Family was educated on the important of maintaining brain function by encouraging the pt to participate in cognitive activities after discharge. As a result of this intervention, the pt has shown significant improvement in.........." I was also warned not to put the word "maintained" in an initial note( I am guessing a D/C note is oK). Medicare in particular wants to see progress. Dementia patients are hard. Medicare is looking for that plateau moment when there isn't anymore significant progress and OT can no longer be justified. Not sure I am on the right track. I just think there is nothing worse for those of us in OT than to know that someone was denied payment because of wording issues. Ron, you clearly see your patients as real people with emotional/social needs and not just a "case". -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Saturday, December 06, 2008 03:46 To: Diane Randall Subject: Re: [OTlist] A "Whopper" of a D/C Note! This patient is on home health and her primary OT diagnosis is dementia. She had NO fine motor issues, in fact her skill with a crotchet needle was quite amazing. What I posted is the entire D/C note. The question of reimbursement is interesting. I'm unsure what Medicare might say if they audited my record. Your questions prompted me to look at this patient's goals and I clearly see there is inconsistency between the goal and the d/c note. That itself, is enough for Medicare to deny payment. I'm disappointed with myself because I did not document a good case for my intervention. This is one of those cases where I feel that OT services were of great benefit to this patient's health, but that insurance could care less. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Diane Randall <[EMAIL PROTECTED]> Sent: Friday, December 05, 2008 To: [email protected] <[email protected]> Subj: [OTlist] A "Whopper" of a D/C Note! DR> OK Ron, I am confused. can you really write notes like that? I was told to DR> never put the actual intervention into a note.....especially "crochet". This DR> sounds like a note from a mental health clinic. It is not Phys Dis, is it? DR> Did she have some sort of fine motor issue? The note would certainly not DR> indicate this...I mean... how could this possibly be billable..at all...even DR> if you reworded it? Is renewing an interest in "occupation" billable? Was DR> there more to the note? Confused -as-usual-student-in-training Diane DR> -----Original Message----- DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] DR> Behalf Of Ron Carson DR> Sent: Thursday, December 04, 2008 19:00 DR> To: [email protected] DR> Subject: [OTlist] A "Whopper" of a D/C Note! DR> Check out this D/C note. Can you imagine what a doctor will say *IF* DR> they ever read this note.... DR> "At evaluation, the patient was devoid of any meaningful or productive DR> occupation (activity). As such, the primary role of OT was DR> facilitating the patient to re-initiate her interest in the occupation DR> of crocheting. At d/c, the patient showed interest and spontaneously DR> participated in her previous occupation. Her husband was educated on DR> the benefit of keeping the patient appropriately engaged in this DR> occupation." DR> You know, being an OT is at time wonderful. In one day, I was seeing a DR> patient to facilitate her engagement in crocheting and facilitating DR> another patient to stand from her wheelchair. The diversity of our DR> profession never ceases to amaze me!!! DR> OT - The (O)ther (T)herapy <smile> DR> Ron DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
