Difference between Ambulation and Gait training - Ron

[Guest guest]

The difference between ambulation and gait training is particularly significant

when dealing with Medicare, Medicaid (CMS) Intermediaries and Insurance

entities. The Medicare guidelines are succinct and an excellent guideline.

Each intermediary publishes their own LCD (Local Coverage Determination), and

you can access this on the Internet.

A good thing to remember regardless of the topic or discipline (ambulation/gait

training, dressing/ compensatory strategies, eating/ swallowing):

Anything " routine and repetitive " is considered unskilled by CMS, therefore

unpaid. There are exceptions to this, when the " skills of a therapist " are

required even in repetitive task, because non-skilled staff would place the

patient at risk, such as when the aggregate of medical issues require the

therapist to constantly monitor risk factors. Extreme risk factors establish

Medical Necessity, the benchmark utilized by CMS to determine payment. Medical

Necessity occurs when the overall medical/clinical complexity of the patient

requires a therapist to ensure safety and progress during any rehabilitative

interventions OR when the complexity of the intervention is such that it can

only be carried out by a therapist. Naturally, we must prove this is our

documentation.

AMBULATION:

Ambulation is merely walking, with or without an assistive device. Anyone on

staff can perform this task. Ambulation to increase distance or endurance is

again, unskilled. This is routine and repetitive. Remember that Strength or

Endurance training in and of themselves are ALSO excluded from CMS payment.

They are considered repetitive and non skilled. In other words, a patient can

be put on a walking program or an exercise program without ongoing treatment, in

the eyes of payors, unless we demonstrate otherwise (Medical Necessity).

GAIT TRAINING:

Gait training, on the other hand, is evaluative by nature and demands active

intervention of the therapist - heel strike, stance, scissoring excetera.....

these are all measurable components that can ONLY be addressed by a therapist.

Addressing related postural issues of midline, pelvic tilt, head position etc.,

and the interventions provided by the therapist are also components that

differentiate simple ambulation from skilled gait training. If you are doing

these things, monitoring, manipulating the body, facilitating certain movement,

inhibiting others, adjusting stride, toe/heel touch etc--- THIS is gait

training. Distance may be one of the measurements used, but a " with " portion of

the goal that refers to method and or actual patient problem, will help

establish that you are gait training rather than merely dragging someone up and

down the hall. (As you know, this is the unfortunate assumption of many

reviewers.)

Hope this helps....

CeCe Todd, Education and Development

The Summit Health and Rehab

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