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Notes on filling the Kcmo Codes Information Bulletin No 110 Part A 2013 2019

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Kcmo Codes Information Bulletin No 110 Part A 2013 2019 : Customize, Finish and forward

July 1st is a challenge and an.opportunity primarily for g-codes.so in Medicare's requirement.for utilizing g-codes the therapist has.a job on evaluation for example of a.patient in order to determine what's.their primary functional limitation.their primary functional limitation.needs to be described by one of the.g-code available numeric representations.so there's numbers associated with the.different categories and the therapist.has to decide for this individual.patient what is your primary limiter.right now so you could have a patient.with a shoulder and a knee condition.let's say for example and they have.issues in lifting and caring but they.also have issues in mobility you have to.choose the primary limiter right now and.so once you've chosen that that's your G.code that you're determining for this.patient and besides reporting that G.code what you need to do you have to.tell Medicare also how severely limited.restricted are they for that issue so.let's say we chose lifting and carrying.how restricted are they in lifting and.carrying and so you do that you have to.make a choice about that and we can talk.about that in a second and then you have.to say where do I think there'll be a.discharge so just like we do typically.in prognosis with patients on eval we.say okay a discharge I think you could.recover so much that you're this much.limited and that would be your goal code.for that G code and the severity.modifier that reflects how much.limitation you think they'll have at.that time period so that's what a.physical therapist needs to determine so.how do we determine that what we have.really three major things that factor.into determining what what our primary.limiters are and how to describe them to.Medicare with these severity modifiers.so we have functional functional.information or functional outcome.measures they're really in two.categories one category is self-report.and those are things that people talk.about the - the disabilities of the arm.shoulder hand us Westry low back.disability index neck disability index.and there's many others those really are.self-reported.the patient is is answering questions.about how they're functioning and.performing the second one is functional.performance measures those are things.that we are measuring in the clinic.ourselves such as distance walk in a.certain time number of times rising and.lowering from a chair.for example in a set period of time so.those are those are really performance.based measures I'm watching you're.performing am measuring your performance.so what happens in those two categories.is that we have to interpret that data.so what does that mean for us.we have to say okay your score was this.on this self-report and so what does.that mean to me as a therapist well I.have to look and see how is that.described in the literature is that data.related to risk because you scored on.this you're at risk for something or is.that data used more to say it's been.described as categories of disability.this would be severely disabled this.would be moderately disabled mildly.disabled that's not uncommon with many.of those measures that they had that.kind of a description or one example.could be 0 to 100 scale where a hundred.percent is a hundred percent impaired.and zero is no impairment there's no.real anchors in between that's all we.know so you're somewhere between no.impairment and and an 100 percent.impairment that it can be interpreted by.the therapist to say what does this mean.to me so we have to go on what the.literature suggests is the.interpretation of that scale then we can.add in a performance based measure that.we actually saw and that also has to be.interpreted so how do we do that we can.compare it to age match norms so if an.eighth person of the same age and same.sex sometimes they're divided also by.male and female would perform at this.distance or the speed or this time then.I can compare how close my patient is to.that that normative person or what would.their peers be performing like I can.also compare it to people in their own.population so a sub population like.patients with Parkinsons so where is my.patient performing based on how patients.with Parkinsons perform on this measure.or conversely I can interpret it as a.risk so if you are this slow at doing.something or slower then you're at risk.for Falls a high risk for Falls if.you're this slow you're a medium risk.for Falls so I have important.information in that column that I can.use to say wow this is telling me this.patient is pretty far from their age.match peers and some of these measures.are interpreted as severely disabled I.take that information and then I move on.to my evaluate.like we typically do and collect my.clinical data range of motion strength.balance screening other types of.coordination other types of measures.that we typically do in an evaluation.and I interpret all that data how.restricted is their strength how.restricted is their range how limited.are they in their coordination and then.I've got some clinical data that I'm.used to collecting and interpreting on.you know that person seems worse off.because they not only have a range.restriction but they have 50% strength.loss this person has a range restriction.and 10% strength loss there's a.difference between those two and how.impaired they are then I go on to a.third category which is other but it's.all the other things we have to consider.comorbidities activity level the.function and participation that they're.returning to their resources living.alone having a supportive spouse and.family all the things that we already.factored in to prognosis in physical.therapy also have to be included here.the therapist takes all of that.information and says okay in my judgment.considering how they performed on these.self-report and functional measures the.data that I collected that showed how.weak or strong they were and how much.range loss and all the other measures.that we collect and considering the.activities they have to return to the.resources available to them the support.system that they have when I take all of.that together I now have to say they are.limited to what amount and when you do.that that's really what your severity.modifiers are reflecting and the key is.that that therapist judgment is there.for a reason it's really important when.you think about therapists judgment what.you're saying is you need to consider.all of these factors and we do this in.prognosis every day in the clinic I say.I see to patients status post total knee.and I'm telling you this one's gonna get.better twice as fast as that one because.there's all these comorbidities and.they're not responding the same so we're.used to this we're good at this that's.it's our time to shine in in judgment we.have to take all that information and.make a judgment based on this condition.and that is our severity modifier and.it's in percentages you know they're 30.percent limited 40 55 and then you look.to see what what.category that falls in on the severity.modifier scale and it assigns two.letters to that a see something and it.tells you how how much impair do you.think that patient is and that's again.typical for what we do clinically it's.just being applied now to that specific.limitation that we said was the primary.one at the first time period so we have.our G code which reflects that activity.or limitation and then how much so and.that's really a severity modifier that.we attached.

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