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.
1 + 1 = OCCUPATION
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.
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.
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Here is the FREE formula worksheet to determine which OT
evaluation code you need to use:
 |
| CLICK TO DOWNLOAD YOUR WORKSHEET |
References for this information are included in the worksheet
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