Ot working under a PT script

March 27, 2007

Everyone, I just heard of an interesting scenario and was wondering about

what anyone would know.

An occupational therapist who works in a local hospital is certified in

lymphedema treatment. She states that she treats lymphedema patients who have

been evaluated by either a PT or an OT since she is a " lymphedema therapist " .

Also in the hospital there is a LMT who sees lymphedema patients who have

been evaluated by physical or occupationa therapists.

They did not mention the billing aspect but I was wondering about the

practice acts or legal issues. My understanding is that an LMT can not work

under

a PT or an OT. Also, my understanding is that cross treatment from another

disciplines evaluation is against the practice acts as well.

It may be different in hospitals in Florida but I would appreciate any

comments regarding this situation.

Kunkel MSPT

************************************** AOL now offers free email to everyone.

Find out more about what's free from AOL at http://www.aol.com.

March 27, 2007

Maybe I'm confused, but if she is an OT - why isn't she doing her own

evaluations. Regardless if her specialty is lymphadema, she is still an

OT and should be able to do her own evals. It seems no different from

an aquatic physical therapist - they are still PTs and do their own

evaluations.

Our state practice act allows PT and OT to work as 'supportive

personnel' under each others act. We do this strictly when someone is

absent, calls out sick etc - in order for the patient to be treated w/o

delay. Patients are only given to therapists that are qualified and

trained to work with them. For example, we would never give a hand

patient to a PT, or a neck patient to an OT, etc. Also when billing,

we bill under whoever's plan of care is being followed. If a PT sees a

shoulder patient under the OT's POC, we bill as OT services - the PT

documents all information and signs all documentation as a PT, but it's

the POC that's being followed per billing. We received confirmation by

our CMS intermediary as well.

IF the PT writes 'lymphadema management' as part of their POC, I would

recommend that they receive an order from the patient's referring MD to

be evaluated and treated by the OT for lymphadema management. I would

assume the lympadema therapist (OT) would have his/her own goals and

treatment plan relating to the patient's diagnosis.

We currently have an OT part-way through her lymphademia certification,

and she will be doing her own evaluation and establishing her own POC.

Hope this helps,

Kimberley Palma

Office Manager - ECHN Rehabilitation Services

Connecticut

_____

From: PTManager [mailto:PTManager ] On

Behalf Of Hellowpb@...

Sent: Tuesday, March 27, 2007 8:26 AM

To: ptmanager

Subject: Ot working under a PT script

Everyone, I just heard of an interesting scenario and was wondering

about

what anyone would know.

An occupational therapist who works in a local hospital is certified in

lymphedema treatment. She states that she treats lymphedema patients who

have

been evaluated by either a PT or an OT since she is a " lymphedema

therapist " .

Also in the hospital there is a LMT who sees lymphedema patients who

have

been evaluated by physical or occupationa therapists.

They did not mention the billing aspect but I was wondering about the

practice acts or legal issues. My understanding is that an LMT can not

work under

a PT or an OT. Also, my understanding is that cross treatment from

another

disciplines evaluation is against the practice acts as well.

It may be different in hospitals in Florida but I would appreciate any

comments regarding this situation.

Kunkel MSPT

************************************** AOL now offers free email to

everyone.

Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

March 27, 2007

We have a similar situation at our facility, where sometimes the lymphedema

therapy will be provided by either a PT or OT. There are a few administrative

elements that have to be in place to make it work effectively (common approach

to care, same paperwork, referral paperwork that allows flexibility, etc.),

but--after checking with the respective licensing boards--the key is that if one

discipline treats a patient evaluated by another discipline, the second

discipline does have to do an evaluation as part of his or her first visit.

As a practical matter, the evaluation consists of considering the evaluation

written by the other discipline, and then either concurring or modifying the

plan of care. It seems complex, but for lymphedema, with therapists who have

similar training, it is a practical way to meet the requirements of the practice

acts and does not take a lot of extra time for data-gathering. We choose not to

charge for the second evaluation; the charges are only for the therapy provided

during the visit.

Bob Perlson

Director, Rehabilitation Services

Asante Health System

Medford OR 97504

Ot working under a PT script

Everyone, I just heard of an interesting scenario and was wondering about

what anyone would know.

An occupational therapist who works in a local hospital is certified in

lymphedema treatment. She states that she treats lymphedema patients who have

been evaluated by either a PT or an OT since she is a " lymphedema therapist " .

Also in the hospital there is a LMT who sees lymphedema patients who have

been evaluated by physical or occupationa therapists.

They did not mention the billing aspect but I was wondering about the

practice acts or legal issues. My understanding is that an LMT can not work

under

a PT or an OT. Also, my understanding is that cross treatment from another

disciplines evaluation is against the practice acts as well.

It may be different in hospitals in Florida but I would appreciate any

comments regarding this situation.

Kunkel MSPT

************************************** AOL now offers free email to everyone.

Find out more about what's free from AOL at http://www.aol.com.

March 27, 2007

In the state of land both PT and OT are considered separate disciplines

regardless of if both are certified in lymphedema. The land Board of

Examiners ruled specifically on this particular issue on April 2006 stating that

they can not cross treat.

Dr. Sumesh , PT, MPT, DPT

Ot working under a PT script

Everyone, I just heard of an interesting scenario and was wondering about

what anyone would know.

An occupational therapist who works in a local hospital is certified in

lymphedema treatment. She states that she treats lymphedema patients who have

been evaluated by either a PT or an OT since she is a " lymphedema therapist " .

Also in the hospital there is a LMT who sees lymphedema patients who have

been evaluated by physical or occupationa therapists.

They did not mention the billing aspect but I was wondering about the

practice acts or legal issues. My understanding is that an LMT can not work

under

a PT or an OT. Also, my understanding is that cross treatment from another

disciplines evaluation is against the practice acts as well.

It may be different in hospitals in Florida but I would appreciate any

comments regarding this situation.

Kunkel MSPT

************ ********* ********* ******** AOL now offers free email to everyone.

Find out more about what's free from AOL at http://www.aol. com.

March 28, 2007

Kimberley,

I question the statement " For example, we would never give a hand patient to

a PT " . Why not? I would never call myself a CHT as I am not but I did

study and learn Physical Therapy evaluation and treatment skills for the

entire upper extremity. As did all my classmates along with all the

graduates from my program. I recognize that hand are a specialized subclass

of patients but for that matter so are spines, vestibular and many other

specialties.

I wonder the clinical rationale behind never giving a hand patient to a PT?

Ford, PT

>

>Reply-To: PTManager

>To: <PTManager >

>Subject: RE: Ot working under a PT script

>Date: Tue, 27 Mar 2007 08:56:07 -0400

>

>Maybe I'm confused, but if she is an OT - why isn't she doing her own

>evaluations. Regardless if her specialty is lymphadema, she is still an

>OT and should be able to do her own evals. It seems no different from

>an aquatic physical therapist - they are still PTs and do their own

>evaluations.

>

>Our state practice act allows PT and OT to work as 'supportive

>personnel' under each others act. We do this strictly when someone is

>absent, calls out sick etc - in order for the patient to be treated w/o

>delay. Patients are only given to therapists that are qualified and

>trained to work with them. For example, we would never give a hand

>patient to a PT, or a neck patient to an OT, etc. Also when billing,

>we bill under whoever's plan of care is being followed. If a PT sees a

>shoulder patient under the OT's POC, we bill as OT services - the PT

>documents all information and signs all documentation as a PT, but it's

>the POC that's being followed per billing. We received confirmation by

>our CMS intermediary as well.

>

>IF the PT writes 'lymphadema management' as part of their POC, I would

>recommend that they receive an order from the patient's referring MD to

>be evaluated and treated by the OT for lymphadema management. I would

>assume the lympadema therapist (OT) would have his/her own goals and

>treatment plan relating to the patient's diagnosis.

>

>We currently have an OT part-way through her lymphademia certification,

>and she will be doing her own evaluation and establishing her own POC.

>

>Hope this helps,

>

>Kimberley Palma

>

>Office Manager - ECHN Rehabilitation Services

>

>Connecticut

>

> _____

>

>From: PTManager [mailto:PTManager ] On

>Behalf Of Hellowpb@...

>Sent: Tuesday, March 27, 2007 8:26 AM

>To: ptmanager

>Subject: Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

><http://www.aol.com.>

>

March 28, 2007

Kim,

Under Medicare, if the patient is being seen under an

OT plan of care, the patient must be seen by the OT,

COTA, physician, or where allowed by state and/or

local law, non-physician practitioners.

A PT can't provide and bill for treatment under an OT

plan of care as they are nt qualified and do not meet

the definition of an OT or OTA.

Begin reading on page 153 of what defines a PT, PTA,

OT, and OTA.

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

The same is true for many other payers as well.

Rick Gawenda, PT

President, Section on Health Policy & Administration

APTA

--- " Palma, Kim " wrote:

> Maybe I'm confused, but if she is an OT - why isn't

> she doing her own

> evaluations. Regardless if her specialty is

> lymphadema, she is still an

> OT and should be able to do her own evals. It seems

> no different from

> an aquatic physical therapist - they are still PTs

> and do their own

> evaluations.

>

> Our state practice act allows PT and OT to work as

> 'supportive

> personnel' under each others act. We do this

> strictly when someone is

> absent, calls out sick etc - in order for the

> patient to be treated w/o

> delay. Patients are only given to therapists that

> are qualified and

> trained to work with them. For example, we would

> never give a hand

> patient to a PT, or a neck patient to an OT, etc.

> Also when billing,

> we bill under whoever's plan of care is being

> followed. If a PT sees a

> shoulder patient under the OT's POC, we bill as OT

> services - the PT

> documents all information and signs all

> documentation as a PT, but it's

> the POC that's being followed per billing. We

> received confirmation by

> our CMS intermediary as well.

>

> IF the PT writes 'lymphadema management' as part of

> their POC, I would

> recommend that they receive an order from the

> patient's referring MD to

> be evaluated and treated by the OT for lymphadema

> management. I would

> assume the lympadema therapist (OT) would have

> his/her own goals and

> treatment plan relating to the patient's diagnosis.

>

> We currently have an OT part-way through her

> lymphademia certification,

> and she will be doing her own evaluation and

> establishing her own POC.

>

> Hope this helps,

>

> Kimberley Palma

>

> Office Manager - ECHN Rehabilitation Services

>

> Connecticut

>

> _____

>

> From: PTManager

> [mailto:PTManager ] On

> Behalf Of Hellowpb@...

> Sent: Tuesday, March 27, 2007 8:26 AM

> To: ptmanager

> Subject: Ot working under a PT script

>

> Everyone, I just heard of an interesting scenario

> and was wondering

> about

> what anyone would know.

>

> An occupational therapist who works in a local

> hospital is certified in

> lymphedema treatment. She states that she treats

> lymphedema patients who

> have

> been evaluated by either a PT or an OT since she is

> a " lymphedema

> therapist " .

> Also in the hospital there is a LMT who sees

> lymphedema patients who

> have

> been evaluated by physical or occupationa

> therapists.

>

> They did not mention the billing aspect but I was

> wondering about the

> practice acts or legal issues. My understanding is

> that an LMT can not

> work under

> a PT or an OT. Also, my understanding is that cross

> treatment from

> another

> disciplines evaluation is against the practice acts

> as well.

>

> It may be different in hospitals in Florida but I

> would appreciate any

> comments regarding this situation.

>

> Kunkel MSPT

>

> ************************************** AOL now

> offers free email to

> everyone.

> Find out more about what's free from AOL at

> http://www.aol.com.

> <http://www.aol.com.>

>

> [Non-text portions of this message have been

> removed]

>

> " This message originates from Eastern Connecticut

> Health Network. The information contained in this

> message may be privileged and confidential. If you

> are the intended recipient, you must maintain this

> message in a secure and confidential manner. If you

> are not the intended recipient, please notify the

> sender immediately and destroy this message, Thank

> you. "

>

> [Non-text portions of this message have been

> removed]

>

________________________________________________________________________________\

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March 28, 2007

I would like to hear the rational as well. There certainly is no PT or

OT " ownership " of a particular diagnosis that I am aware of.

I am fascinated that Connecticut allows a PT or OT to " take off " their

professional designation and work as supportive personnel. Where does

the liability lie should an event occur?

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

><http://www.aol.com.>

>

March 28, 2007

Let me clarify - we do NOT take off our professional designation - all

documentation clearly states that the treatment was rendered by an

licensed PT or OT. I was just referencing that the state practice act

(and other documents I have seen, including the APTA - which puts OT's

as supportive personnel under PTs) has a special section that does not

restrict a PT's ability to treat under an OT POC, as long as they are

licensed and qualified to do so. The liability falls under the

hospital as these are hospital employees. What CMS and our state

practice acts allows us to do is to treat under a different POC in order

that the patient is not deferred from receiving care in the event the

therapist is out sick, on FMLA, etc. For example, we have had a

patient with a shoulder DX being treated by the OT and then the OT was

called out unexpectedly for a day or more. The guideline allows that a

PT is allowed to treat that patient under an OT POC, as long as they are

QUALIFIED AND LICENSED to perform those same procedures. The services

are charged under with the OT Modifier -GO since the services were

rendered by following an OT POC - however, all documentation clearly

states the patient was treated by a PT. There is no misrepresentation

in any way, and the patient is ALWAYS informed of this change and they

have the right to decline. We have a very small OT staff, so when

absences occur it puts patients at risk for lost therapy. I want to

stress again that this is NOT a routine occurrence and only happens in

very specific circumstances. Furthermore, our staff is able to decline a

patient that they do not feel comfortable in seeing in this instance.

In terms of 'hand patient' what I meant to say, without making things to

long, is that if the patient is post-op tendon laceration or a more

specific post-op ortho dx, we normally refer those patients to our

OT/CHT. Our PT staff agree that they are not as comfortable with this

particular patient population and we want to put the patient with the

most qualified therapist. This is no different than giving a patient

with vestibular issues to a therapist with more training in vestibular

rehab vs. a therapist who has had limited exposure. Its all about what

is best for the patient. There are certainly several instances where

typical OT patients (i.e. wrist sprains, CTS, etc) are given to PT staff

to evaluate/treat, etc. especially when OT schedules are fully

maximized.

I hope this clarifies things

Kimberley Palma

>Office Manager - ECHN Rehabilitation Services

>Connecticut

>

_____

From: PTManager [mailto:PTManager ] On

Behalf Of Ron Barbato

Sent: Wednesday, March 28, 2007 10:24 AM

To: PTManager

Subject: RE: Ot working under a PT script

I would like to hear the rational as well. There certainly is no PT or

OT " ownership " of a particular diagnosis that I am aware of.

I am fascinated that Connecticut allows a PT or OT to " take off " their

professional designation and work as supportive personnel. Where does

the liability lie should an event occur?

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@... <mailto:rbarbato%40emrmc.org>

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Kim,

Under Medicare, a PT or PTA can't provide and bill for

services under an OT POC and use the GO modifier after

the CPT code. PT's and PTA's are not qualified

providers of OT services. See my previous post for the

reference.

If the PT and/or PTA provdies services to a Medicare

beneficiary, it must be under a PT POC that has been

certified by the physician or non-physician

practitioner.

Feel free to contact me directly for further

discussion

Rick Gawenda, PT

President, Section on Health Policy & Administration

APTA

--- " Palma, Kim " wrote:

> Let me clarify - we do NOT take off our professional

> designation - all

> documentation clearly states that the treatment was

> rendered by an

> licensed PT or OT. I was just referencing that

> the state practice act

> (and other documents I have seen, including the APTA

> - which puts OT's

> as supportive personnel under PTs) has a special

> section that does not

> restrict a PT's ability to treat under an OT POC, as

> long as they are

> licensed and qualified to do so. The liability

> falls under the

> hospital as these are hospital employees. What CMS

> and our state

> practice acts allows us to do is to treat under a

> different POC in order

> that the patient is not deferred from receiving care

> in the event the

> therapist is out sick, on FMLA, etc. For example,

> we have had a

> patient with a shoulder DX being treated by the OT

> and then the OT was

> called out unexpectedly for a day or more. The

> guideline allows that a

> PT is allowed to treat that patient under an OT POC,

> as long as they are

> QUALIFIED AND LICENSED to perform those same

> procedures. The services

> are charged under with the OT Modifier -GO since the

> services were

> rendered by following an OT POC - however, all

> documentation clearly

> states the patient was treated by a PT. There is no

> misrepresentation

> in any way, and the patient is ALWAYS informed of

> this change and they

> have the right to decline. We have a very small OT

> staff, so when

> absences occur it puts patients at risk for lost

> therapy. I want to

> stress again that this is NOT a routine occurrence

> and only happens in

> very specific circumstances. Furthermore, our staff

> is able to decline a

> patient that they do not feel comfortable in seeing

> in this instance.

>

> In terms of 'hand patient' what I meant to say,

> without making things to

> long, is that if the patient is post-op tendon

> laceration or a more

> specific post-op ortho dx, we normally refer those

> patients to our

> OT/CHT. Our PT staff agree that they are not as

> comfortable with this

> particular patient population and we want to put the

> patient with the

> most qualified therapist. This is no different than

> giving a patient

> with vestibular issues to a therapist with more

> training in vestibular

> rehab vs. a therapist who has had limited exposure.

> Its all about what

> is best for the patient. There are certainly

> several instances where

> typical OT patients (i.e. wrist sprains, CTS, etc)

> are given to PT staff

> to evaluate/treat, etc. especially when OT schedules

> are fully

> maximized.

>

> I hope this clarifies things

>

> Kimberley Palma

> >Office Manager - ECHN Rehabilitation Services

> >Connecticut

> >

>

> _____

>

> From: PTManager

> [mailto:PTManager ] On

> Behalf Of Ron Barbato

> Sent: Wednesday, March 28, 2007 10:24 AM

> To: PTManager

> Subject: RE: Ot working under a PT

> script

>

> I would like to hear the rational as well. There

> certainly is no PT or

> OT " ownership " of a particular diagnosis that I am

> aware of.

> I am fascinated that Connecticut allows a PT or OT

> to " take off " their

> professional designation and work as supportive

> personnel. Where does

> the liability lie should an event occur?

>

> Ron Barbato PT

> Corporate Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@... <mailto:rbarbato%40emrmc.org>

>

> RE: Ot working under a PT

> script

> >Date: Tue, 27 Mar 2007 08:56:07 -0400

> >

> >Maybe I'm confused, but if she is an OT - why isn't

> she doing her own

> >evaluations. Regardless if her specialty is

> lymphadema, she is still

> an

> >OT and should be able to do her own evals. It seems

> no different from

> >an aquatic physical therapist - they are still PTs

> and do their own

> >evaluations.

> >

> >Our state practice act allows PT and OT to work as

> 'supportive

> >personnel' under each others act. We do this

> strictly when someone is

> >absent, calls out sick etc - in order for the

> patient to be treated w/o

> >delay. Patients are only given to therapists that

> are qualified and

> >trained to work with them. For example, we would

> never give a hand

> >patient to a PT, or a neck patient to an OT, etc.

> Also when billing,

> >we bill under whoever's plan of care is being

> followed. If a PT sees a

> >shoulder patient under the OT's POC, we bill as OT

> services - the PT

> >documents all information and signs all

> documentation as a PT, but it's

> >the POC that's being followed per billing. We

> received confirmation by

> >our CMS intermediary as well.

>

=== message truncated ===

________________________________________________________________________________\

____

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March 28, 2007

Kim,

Under Medicare, a PT or PTA can't provide and bill for

services under an OT POC and use the GO modifier after

the CPT code. PT's and PTA's are not qualified

providers of OT services. See my previous post for the

reference.

If the PT and/or PTA provdies services to a Medicare

beneficiary, it must be under a PT POC that has been

certified by the physician or non-physician

practitioner.

Feel free to contact me directly for further

discussion

Rick Gawenda, PT

President, Section on Health Policy & Administration

APTA

--- " Palma, Kim " wrote:

> Let me clarify - we do NOT take off our professional

> designation - all

> documentation clearly states that the treatment was

> rendered by an

> licensed PT or OT. I was just referencing that

> the state practice act

> (and other documents I have seen, including the APTA

> - which puts OT's

> as supportive personnel under PTs) has a special

> section that does not

> restrict a PT's ability to treat under an OT POC, as

> long as they are

> licensed and qualified to do so. The liability

> falls under the

> hospital as these are hospital employees. What CMS

> and our state

> practice acts allows us to do is to treat under a

> different POC in order

> that the patient is not deferred from receiving care

> in the event the

> therapist is out sick, on FMLA, etc. For example,

> we have had a

> patient with a shoulder DX being treated by the OT

> and then the OT was

> called out unexpectedly for a day or more. The

> guideline allows that a

> PT is allowed to treat that patient under an OT POC,

> as long as they are

> QUALIFIED AND LICENSED to perform those same

> procedures. The services

> are charged under with the OT Modifier -GO since the

> services were

> rendered by following an OT POC - however, all

> documentation clearly

> states the patient was treated by a PT. There is no

> misrepresentation

> in any way, and the patient is ALWAYS informed of

> this change and they

> have the right to decline. We have a very small OT

> staff, so when

> absences occur it puts patients at risk for lost

> therapy. I want to

> stress again that this is NOT a routine occurrence

> and only happens in

> very specific circumstances. Furthermore, our staff

> is able to decline a

> patient that they do not feel comfortable in seeing

> in this instance.

>

> In terms of 'hand patient' what I meant to say,

> without making things to

> long, is that if the patient is post-op tendon

> laceration or a more

> specific post-op ortho dx, we normally refer those

> patients to our

> OT/CHT. Our PT staff agree that they are not as

> comfortable with this

> particular patient population and we want to put the

> patient with the

> most qualified therapist. This is no different than

> giving a patient

> with vestibular issues to a therapist with more

> training in vestibular

> rehab vs. a therapist who has had limited exposure.

> Its all about what

> is best for the patient. There are certainly

> several instances where

> typical OT patients (i.e. wrist sprains, CTS, etc)

> are given to PT staff

> to evaluate/treat, etc. especially when OT schedules

> are fully

> maximized.

>

> I hope this clarifies things

>

> Kimberley Palma

> >Office Manager - ECHN Rehabilitation Services

> >Connecticut

> >

>

> _____

>

> From: PTManager

> [mailto:PTManager ] On

> Behalf Of Ron Barbato

> Sent: Wednesday, March 28, 2007 10:24 AM

> To: PTManager

> Subject: RE: Ot working under a PT

> script

>

> I would like to hear the rational as well. There

> certainly is no PT or

> OT " ownership " of a particular diagnosis that I am

> aware of.

> I am fascinated that Connecticut allows a PT or OT

> to " take off " their

> professional designation and work as supportive

> personnel. Where does

> the liability lie should an event occur?

>

> Ron Barbato PT

> Corporate Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@... <mailto:rbarbato%40emrmc.org>

>

> RE: Ot working under a PT

> script

> >Date: Tue, 27 Mar 2007 08:56:07 -0400

> >

> >Maybe I'm confused, but if she is an OT - why isn't

> she doing her own

> >evaluations. Regardless if her specialty is

> lymphadema, she is still

> an

> >OT and should be able to do her own evals. It seems

> no different from

> >an aquatic physical therapist - they are still PTs

> and do their own

> >evaluations.

> >

> >Our state practice act allows PT and OT to work as

> 'supportive

> >personnel' under each others act. We do this

> strictly when someone is

> >absent, calls out sick etc - in order for the

> patient to be treated w/o

> >delay. Patients are only given to therapists that

> are qualified and

> >trained to work with them. For example, we would

> never give a hand

> >patient to a PT, or a neck patient to an OT, etc.

> Also when billing,

> >we bill under whoever's plan of care is being

> followed. If a PT sees a

> >shoulder patient under the OT's POC, we bill as OT

> services - the PT

> >documents all information and signs all

> documentation as a PT, but it's

> >the POC that's being followed per billing. We

> received confirmation by

> >our CMS intermediary as well.

>

=== message truncated ===

________________________________________________________________________________\

____

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March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Making sure a patient receives the most appropriate care by scheduling

with a specialized practice PT or OT is one thing, treating under

another's POC is quite a different story. State law does not outweigh

Federal law.

I believe your practice is putting your therapists at risk

Ron Barbato PT

Corporate Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

Ot working under a PT script

>

>Everyone, I just heard of an interesting scenario and was wondering

>about

>what anyone would know.

>

>An occupational therapist who works in a local hospital is certified in

>lymphedema treatment. She states that she treats lymphedema patients

who

>have

>been evaluated by either a PT or an OT since she is a " lymphedema

>therapist " .

>Also in the hospital there is a LMT who sees lymphedema patients who

>have

>been evaluated by physical or occupationa therapists.

>

>They did not mention the billing aspect but I was wondering about the

>practice acts or legal issues. My understanding is that an LMT can not

>work under

>a PT or an OT. Also, my understanding is that cross treatment from

>another

>disciplines evaluation is against the practice acts as well.

>

>It may be different in hospitals in Florida but I would appreciate any

>comments regarding this situation.

>

> Kunkel MSPT

>

>************************************** AOL now offers free email to

>everyone.

>Find out more about what's free from AOL at http://www.aol.com.

<http://www.aol.com.>

><http://www.aol.com. <http://www.aol.com.> >

>

March 28, 2007

Whoa . Long before OT's became the hot bed for hands lot of PT's

treted hand related problems. Most of us older guys are generalist in a

given area (ortho, neuro etc)and have a special interest in something.

I am not CHT but 50% of what I do is hand and elbow related. Most of my

con ed is hand related including 3 trips in the last 5 years to the

Philadelphia Hand meeting. Usually the PT's are 10-20% of the crowd. I

simply don't want to prepare for a cetification exam. We also used to

do pulmonary (happiness to me is a clean chest) and other rehab

activities that we have let slip away. Newer PT's all want to

specialize and this is not a bad thing but if you are in a rural

area...well necessity is the mother of invention. Our new therapist

don't want to touch a hand patient. Even a distal radius fx. I guess

thats ok too. Please lets not throw out the baby with the bath water.

Mike , PT

Rehab South, PC

Jasper, AL

March 28, 2007