Tuesday, December 27, 2016


HUGE ANNOUNCEMENT for my fellow Occupational Therapists! 

If you have yet to hear the news, the evaluation codes we choose to initiate our plan of care in serving our patients (in the realm of physical medicine and rehabilitation) is changing and fast! January 1st, 2017 to be exact.

Here is what you need to know before plugging in any evaluation code and how to decide on the right code to choose:

1.    It is a formula!
o   You plug the measures into each equation and come out with a result or answer. This answer indicates a level of complexity. That level of complexity determined by you is reflected as your OT evaluation code.
o   The worksheet included helps you decipher what measurement to plug in and where to get your answer to the equation. It is super simple if you go through the process in using the formula, for each and every patient. 


2.     DO NOT pay attention to the time indicated beside the code, it is irrelevant. Here’s why:
o   The code (for evaluation only not a standard visit with treatment only) is chosen based on a formula, not how long a therapist conducted an evaluation for.
o   The time is a projected or an educated guess of how long it may take to complete the level of complexity for an OT evaluation. THIS IS NOT utilized to formulate the data needed to decide on which code to choose.
o   At this time, each choice in code reflects the combined level of complexity in three categories (it is like a math problem based on three variables…consider it algebra)
o   The code is not reflective of the time spent doing any of the evaluation specifications but the “how” of deciding on which code to choose; this is determined with the step by step completion of the formula in the worksheet
o   The code costs may or may not be the same (depends on payer as time goes on and this may change in the future)
o   Each code is 1 unit; however, this does not mean choosing any code blindly or impulsively will suffice. You really have to ask yourself: how complex is this case? We will explore more why it is important to choose the right code in the next section!

3.    The codes directly reflect how valuable the OT profession is to our clients:
o   It indicates how complex our assessments are for individual patient cases; the higher level of complexity involved in each of the three criteria levels, the greater the combined level of complexity, resulting in a determined code.
o   The code reflects that our time is valued for the level of complexity in evaluation and developing a plan of care; this means quality of care is important and highlighted in the process.
o   It encourages and allows us to remain consistent with our OT framework
o   It is a tool to communicate our distinct value
o   It directly reflects how holistic we are
o   It helps us to remain ethical in clinical decision making
o   It helps us provide evidence as to why we choose the code we decide upon
o   It helps us advocate as individual practitioners; no other individual is allowed to decide a code for us.
o   When conducting an evaluation and formulation of a plan of care for our clients, only the OT practitioner may do so, reflected in their choosing of the code for that evaluation.
4.    The new OT evaluation codes are a collection of data.
o   This data collection reflects a skilled OT need in variety of MD referrals for a patient to receive consultation.
o   Why is this important? It appears to determine where OT is needed, where OT should be continued and where services in the community are lacking (all under the umbrella of physical medicine and rehabilitation).
o   It appears it will likely be greatly utilized in the future of other OT settings (mental health perhaps? Primary care? Community based private clinics?)
o   This data collection will also likely influence payer sources in the future to determine what payment is allotted for patient therapy costs, starting right at the beginning at evaluation.
o   As time goes on, our data input (aka OT evaluation code selection) may reflect what is covered in the future; therefore, we must be accurate in selection to continue to serve patients.

5.    Code selection is (and always will be) determined by the therapist, not administrators.
o   ethical and legal standards practiced strictly by the therapist conducting the evaluation is reflective of how we serve our clients and whether we get to continue to do so
o   Our unique role and professional, skilled expertise as occupational therapists allows us to make a decision or conclusion of which code to choose.
o   Code selection is based on four components completed in the evaluation process. This can only be done by the skilled therapist, therefore, no other discipline or individual can reflect which code is chosen for evaluation. 
6.    OT evaluations remain the same; they are just broken down into levels reflected in the code we choose
o   There is specific and stated criteria to determine which is an appropriate OT evaluation code to choose (listed in the worksheet).
o   Evaluation has four components; three of which when combined and formulated effectively, determine the code we choose.
o   We normally gather data to form an:
                                               i.     occupational history, as well as medical history, to determine a patient’s prior level of function
                                             ii.     whether the client has a change in functional performance and how we are utilizing our assessments
                                            iii.     clinical reasoning/decision making ability to determine an appropriate plan of care.
o   These codes directly reflect that we are clearly doing our job in the evaluation process. Consider them check boxes to mark off your evaluation checklist; use it as you complete your formal evaluation.
o   It ensures all aspects of an evaluation are covered and it will be individualized for each patient served. How complex is our case and how complex is the process to get a thorough assessment and implement a plan?

7.    Three of four components of the evaluation determine the code you choose
o   1. Occupational profile, client history (medical and therapy) 2. Assessment of occupational performance 3. Clinical decision making
o   once the level of complexity is chosen for each of these components, a overall, comprehensive level of complexity is decided (they are plugged into the formula, which is reflected as the OT evaluation code chosen).
o   The fourth component completed in the evaluation is developing the plan of care. This is directly reflected in the holistic assessment of the three component formula.

Now it is time to conduct your OT evaluation! The worksheet formula breaks down and guides you through how to choose the accurate code for each and every individual patient you evaluate. 
Deciding which OT evaluation code to use starting Jan 1st 2017 is a several step process! 
Decipher how to rank the level of complexity in the OT evaluation code you choose! This worksheet is designed to make it simple for the therapist to breakdown. In a step by step format, you will know how to choose the code to use for evaluation. 
This will decrease some of the confusion and bring our OT evaluation process back to serving the client. Stay ethical and legal with the need to know information. 

Here is the FREE formula worksheet to determine which OT evaluation code you need to use:

References for this information are included in the worksheet

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