code webinar 3b - spsco · • therapists notes: ck level to ... • utilization beyond simple...

CODE | SPS | WWW.SPSCO.COM

Documenting a K2 patient with K3 expectation

Molly McCoy, L/CPO McCoy Consulting, LLC

CODE Webinar 3


•  The Claim •  The Denial •  The Appeal

•  Another example of K2 to K3 •  Side note: Integrating doctors notes into yours •  Side note: Showing trends in patient info

Overview


The Claim

•  Over 100 pages of documentation •  Doctors •  Hospital •  Podiatry •  Therapist •  Prosthetist

•  Typed practitioner notes •  Letter of Medical

Necessity from the doctor

•  K2 level components •  L5673 $1900 •  L5645 $1100 •  L5972 $500 •  L5986 $950

•  Photographs •  Patient standing in

prosthesis •  Residual limb


•  From Medicare: •  Additional Documentation Request (ADR) •  “No documentation sent” •  Denied in it’s entirety

•  Currently in appeal

The Denial


•  Therapists notes: CK level to CI level in 3 months •  What is a C level?

•  Recent CMS mandate for therapists •  Severity level indicators

•  What’s a CK or CI level mean? •  CH= 0% impaired •  CI = 1%-19% impaired •  CJ = 20%-39% impaired •  CK = 40%-59% impaired •  CL = 60%-79% impaired •  CM = 80%-99% impaired •  CN = 100% impaired

The Appeal Will reach K3 in a reasonable time


•  Therapists notes: •  “I want to be able to walk normally again”

•  Satisfaction survey from Prosthetist’s office: •  The prosthesis has “given me my life back”

•  Photographs •  Patient standing independently with the prosthesis

The Appeal Motivation & desire to ambulate


•  Prosthetist notes: •  Worked construction 12 months ago •  3 children at home •  Suture line healed

•  Picture submitted

The Appeal Beneficiary’s past history, current condition,

other medical problems




•  Doctors notes: •  Ulcers on feet •  Able to undergo

anesthesia for surgery •  Required to be non-

weight bearing •  Orders for prosthesis

and therapy

•  Additional info: •  Primary care note

regarding medical management of hypertension •  HBP will not limit

ambulation •  Primary care note

recommending exercise or weight loss •  Prosthesis will

encourage exercise


•  Therapist notes: •  Shoulder pain with wheelchair use •  High BMI due to period of decreased activity




•  Cause of current K2 level •  12 months of wound care •  Non-weight bearing during healing •  General deconditioning

The Appeal K2 level currently K3 level expected


•  Previous Activity Level •  Construction work

•  Physically demanding •  Patient in good shape prior to wound care/

amputation •  Home maintenance & Independent living

•  Kneeling, bending, moving in confined areas •  Specifics: repairs plumbing, mows lawn, maintains

pool, repairs vehicles, etc… •  Childcare

•  Walking on uneven ground during children’s activities

•  Running to keep up with them or keep them safe •  Frequency



•  Post-Rehab Activities •  Variable cadence

•  Patient intends to care for children full time until he returns to work

•  Utilization beyond simple locomotion •  Home therapy program

o  Stretching o  Strengthening

•  Weight loss activities o  Walking 2x/week

•  Meal preparation for self and kids o  Standing o  Moving in confined area



Another Example •  Cause of current K2

•  Recent amputation surgery •  Use of a wheelchair after

surgery •  Heart & GI complications

after surgery •  Under medical

supervision, controlled with medication per doctor

•  Asthma & COPD •  Under medical

management •  Did not hinder activity

prior to amputation

•  Previous activity •  Working full time •  Caring for live-in elderly

mother •  Spend time with

grandchildren •  Golfing 2 times per week

•  Post-rehab activity •  Home PT program •  Return to previous

activities


•  Evaluation note •  Request doctors notes after this visit •  Review the notes before next appointment

•  Casting note •  Add description and interpretation of doctors notes to this

chart note •  Request therapist notes (or other provider)

•  Check socket fitting note •  Add description and interpretation of doctors notes to this

chart note •  Delivery note

•  Ask patient to write a letter regarding what the prosthesis does for him/her & how he/she will use it

Side Note: Charting technique


•  Flexible Keel Foot •  Flexible forefoot but stiffer than a SACH •  Resistance at late stance •  Maintain balance for long strides

o  Patient is tall •  Support for moving in confined areas

o  Patient prepares meals in the kitchen and cares for himself in the bathroom

The Appeal What are the prosthetic features?


•  Multi-axial Rotation Unit •  Increased movement at ankle

•  Short residual limb o  Absorbs impact of activity o  Patient has decreased surface area to distribute forces

•  History of skin breakdown o  Skin protection, prevents force translation to socket o  Patient activity level & diabetes requires skin protection

•  Movement side to side & backwards o  Prevent force transfer to residuum from kneeling for home

repair or childcare, moving in kitchen & bathroom, & twisting while standing or reaching

The Appeal What are the prosthetic features?


•  Patient is at risk for skin breakdown from residual limb swelling •  Recent amputation •  Past history •  Long wound care treatment course •  Recent use of wheelchair

•  Use of the prosthesis will reduce swelling •  Prosthetists measurements over several visits show

downward trend with use of check socket and prosthesis

The Appeal The prosthesis maintains residual limb health


Side Note: Showing trends


Side Note: Showing trends

16.15

16.2

16.25

16.3

16.35

16.4

1/23/12 2/4/12 4/8/12

average circumference

average circumference


Thank you SPS!

code webinar 3b - spsco · • therapists notes: ck level to ... • utilization beyond simple...

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