A detailed review of criteria policies and guidelines organized by body region for Occupational, Physical and Speech Therapy + inpatient rehabilitation services

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May 7, 2004
Source: Research and Markets
Business Wire 2004

Research and Markets (http://www.researchandmarkets.com) has announced the addition of 2004 Managed Occupational Therapy/Physical Therapy (OT/PT) and Rehab Care Manual to their offering.

The number of visits commonly required to treat specific conditions are listed as well as review criteria guidelines for rehabilitation care admission, continued stay and discharge for common disorders. Example protocols and other tools to improve care are located throughout the manual. Resources include the Oregon pediatric rehabilitation guidelines and example home exercise handouts to give to patients.

Report Contents:
 

• Introduction to rehabilitation services; Utilization management; Medical Necessity Criteria; Physical Medicine and Rehabilitation - Medicare LMRP; Physical Therapy/Occupational Therapy provided by physicians and physician employees Policy; Maintenance Therapy/ Medicare treatment parameters for medically necessary items/services; Therapeutic activities, direct (one on one) patient contact by the provider; Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and propioception, Therapeutic Procedure; Therapeutic exercises to develop strength and endurance, range of motion and flexibility; Physical Therapy - Defined; Automobile Driving Therapy; Level of care for therapy; Therapy and Rehabilitation Modalities - medical review criteria for Medicare Covered (and noncovered) Modalities including: Hot or cold packs, Traction, mechanical, Electrical stimulation, (unattended), Vasopneumatic devices, Paraffin bath, Microwave, Whirlpool, Diathermy, Infrared, Ultraviolet, Laser Physical Therapy; Electrical stimulation, manual, Iontophoresis, Contrast baths, Ultrasound, Hubbard Tank. Specific Medicare Policy Guidelines for procedures including: Therapeutic exercises, Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception, Aquatic therapy with therapeutic exercises, Gait training, Massage, Manual therapy techniques - traction, soft tissue mobilization, manipulation, joint mobilization, Therapeutic procedures (group), Orthotics training, Orthotics fitting and training, Prosthetic training, Therapeutic activities, Self-care/Home management training, Community work/Reintegration training, Training in Activities of Daily Living (ADLs), Wheelchair management/propulsion training, Tests and Measurements, Development of cognitive skills; Sensory integrative techniques, Disease specific guidelines - (Pulmonary, Parkinson's), Maintenance therapy, Work hardening/Conditioning. Therapeutic Ultrasound for wound healing; Training in ADLs;

Post-acute Care Therapy; Maintenance Therapy Criteria; Claims review for therapy services; Physical Medicine Guidelines for Duplicative Services; Occupational Therapy Services; Neuropsychological Testing; Neurocognitive Therapy; Chronic Pain Assessment and Treatment; Pain Rehabilitation Program review criteria; Pharmacologic challenges for sympathetically maintained pain; Gait analysis; Electrodynogram; Phonophoresis; Treatment Plan Modalities - including transfer training, strength, ROM, Pain management review policies; Evaluation (injury, exacerbation, re-injury, pain, strength definitions); Pain Rehabilitation Programs, Outpatient - Medicare LMRP; Chronic Pain Assessment/Pain Centers; Outcome measures for chronic pain management; Pharmacologic Challenges for Sympathetically Maintained Pain - Medicare LMRP; Standing orders for therapy; Outcome management; Functional Independence Measures (FIM); Quality Improvement Guidelines/Outcome studies; Gait Analysis, Computerized; Dynamic, Electromyographic; Gait analyses, Electrodynogram including Medicare P&P; Electrodynogram - Medicare LMRP; Phonophoresis; Treadmill - evaluation and teaching use of - Medicare LMRP; Rehabilitation Treatment Plan Modalities including Transfer Training, Strength, Range of Motion, Pain Management, Other; Acupuncture; Biofeedback; ''Prehab"; Standing orders for therapy services.

• Visit authorization Review Guidelines by Skeletal Structure: Spine: Lumbosacral spine; low back pain, acute and chronic; Disability Periods for Lumbar Disc Disease - by type of treatment; Traction for low back pain; Back School Program, Manipulation of the spine under anesthesia; Lumbar spine, pre-surgical or non-surgical, Lumbar spine, post-surgical, Magnet Therapy for low back pain, Cervical spine, pre-surgical or non-surgical, Cervical spine, post-surgical, Neck Pain, Shoulder: pre-surgical or non-surgical, post-surgical, Total Shoulder - post-operative protocol, Rotator Cuff Repair/Impingement syndrome, Adhesive capsulitis, Ultrasound therapy for calcific tendinitis, shoulder, Elbow: pre-surgical or non-surgical, post-surgical, Lateral and medial epicondylitis, Wrist: pre-surgical or non-surgical, post-surgical, Carpal tunnel syndrome therapy;- Hand/fingers: pre-surgical or non-surgical, post-surgical, Tenosynovitis/Flexor tendinitis involving the hand/fingers, Post Dupuytren's Release OT, Hip: pre-surgical or non-surgical, post-surgical, Total hip replacement, Knee: pre-surgical or non-surgical, Therapeutic Knee Taping - for osteoarthritis pain control; post-surgical, Patello-femoral syndrome, Osteoarthritis of the knee, Total knee replacement, post-op, Complete MCL tears rehabilitation program, ACL reconstruction rehabilitation protocol (Ventura), ACL reconstruction rehabilitation protocol (Appleton), Ankle: pre-surgical or non-surgical, post-surgical, Achilles tendinitis, Ankle sprains/strains, Foot/toes, pre-surgical or non-surgical, Foot/toes, post-surgical, Morton's neuroma, Plantar fasciitis; Amputations, upper or lower extremities;

• Other conditions - treatment review policies: Cerebral Palsy; Foot drop; Hypermobility, Polymyalgia, Multiple Sclerosis; R. A.; Osteoporosis; Reflex Sympathetic Dystrophy (RSD); Fibromyalgia; Botulinum Toxin Injections; Complex Regional Pain Syndrome; Temporomandibular Joint (TMJ) Disorders; Chronic Fatigue Syndrome (CFS); Visual Loss - Medicare Coverage of Rehab Services; Osteoarthritis; Normal Range of Motion, Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy.

• Speech and language therapy review policies - Skilled Speech Services; Unskilled

Speech Services; Aphasia; Vestibular Rehabilitation; Melodic Intonation Therapy for Persistent Aphasia; Speech-Language Initial Visits for Specific Abnormalities; Discontinuation of Speech-Language Benefits; Dysphagia: Oral-Motor Therapy; HCFA Edits for Speech-Language Pathology; Speech-Language Pathology Terms, Acronyms; References and Resources for Speech-Language Therapy

• Acute Inpatient Rehabilitation Services: Review criteria for admission to a rehabilitation hospital, CORF medical review policy; Inpatient assessment of potential for rehabilitation; Clinical conditions; Pre-Admission Authorization Review Rehabilitation Services, Continued Stay Review, Discharge Status Review and Criteria for discharge; ; Case mix, severity and complexity measures; Constraint-induced movement therapy (CIMT)

• References - listed by affected area or topic

• Web sites - web resources related to Disabilities, Physical Therapy, Occupational Therapy and Rehabilitation

• Resources for certification, accreditation, provider networks; Oregon Guidelines for Medically-based Outpatient Physical Therapy and Occupational Therapy for Children with Special Health Needs in the Managed Care Environment; HCFA, Pub 09, Rehabilitation Manual, Chapter II excerpts; HCFA., Pub 10, Hospital Manual, Section 211, Inpatient rehabilitation.

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