Occupational therapy programs tables of content

Pain–Documentation describing the presence or absence of pain and its effect on the patient’s functional abilities must be considered in MR decisions. A description of its intensity, type, changing pattern, and location at specific joint ranges of motion materially aids correct MR decisions. Documentation should describe the limitations placed upon the patient’s ADL, mobility and/or safety, as well as the subjective progress made in the reduction of pain through treatment.

Therapeutic Programs–The objective documentation should support the skilled nature of the program, and/or the need for the design and establishment of a maintenance OT program. The goals should generally be to increase functional abilities in ADL, mobility or patient safety. Documentation should indicate the goals and type of program provided.
Approve claims when the therapeutic program, because of documented medical complications, the condition of the patient or complexity of the OT employed, must be rendered by, or under, the supervision of an occupational therapist. For example, while functional ADL may often be performed safely and effectively by nonskilled personnel, the presence of fracture nonunion, severe joint pain, or other medical or safety complications may warrant skilled occupational therapist intervention to render the service and/or to establish a safe maintenance program. In these cases, the complications and the skilled services, they require, must be documented by physician orders and/or occupational therapist notes. To make correct MR decisions, the patient’s losses and/or dependencies in ADL, mobility and safety must be documented. The possibility of adverse effects from the improper performance of an otherwise unskilled services does not make it a skilled service unless there is documentation to support why skilled OT is needed for the patient’s medical condition and/or safety.
Cardiac Rehabilitation Exercise–Occupational therapy is not covered when furnished in connection with cardiac rehabilitation exercise program services (see Coverage Issues Manual 35-25) unless there is also a diagnosed noncardiac condition requiring it e.g., where a patient who is recuperating from an acute phase of heart disease may have had a stroke which requires OT. (While the cardiac rehabilitation exercise program may be considered by some a form of OT, it is a specialized program conducted and/or supervised by specially trained personnel whose services are performed under the direct supervision of a physician.).
Transfer Training – The documentation should describe the patient’s functional limitations in transfer ability that warrant skilled OT intervention. Documentation should include the special transfer training needed to perform functional daily living skills and any training needed by supportive personnel and/or family members to safely and effectively carry it out. Approve transfer training when the documentation supports a skilled need for evaluation, design and effective monitoring and instruction of the special transfer technique for safety and completion of the functional activities of daily living or mobility task.
Documentation that supports only repetitious carrying out of the transfer method,

once established, and monitoring for safety and completion is noncovered care.

Fabrication of and Training in Use of Orthoses Prostheses and Adaptive Equipment – Approve reasonable and necessary fabrication of orthoses, prostheses, adaptive equipment, and any reasonable and necessary skilled training needed in their safe and effective use. The documentation must indicate the need for the device and training required.
OT Forms – Documentation may be submitted on a specific form you [the carrier] require or may be copies of the provider’s record. However, your form must capture the needed MR information. If you choose to require a particular form, show the OMB clearance number. The information you require to review the bill is that which is required by an occupational therapist to properly treat a patient.
Certification and Recertification – OT services must be certified and recertified by a physician and must be furnished while the patient is under the care of physician. OT services must be furnished under a written plan of treatment established by the physician or a qualified occupational therapist. If the plan is established by an occupational therapist, it must be reviewed periodically by the physician.
The plan of treatment must be established (reduced to writing by either professional or the provider when it makes a written record of oral order) before treatment is begun. When outpatient OT services are continued under the same plan of treatment for a period of time, the physician must certify at least at 30-day intervals that there is a continuing need for them. Obtain the recertification when reviewing the plan of treatment since the same interval of at least 30 days is required for review of the plans. A recertification must be signed by the physician, who reviewed the plan of treatment. Any changes to the treatment plan established by the occupational therapist must be in writing and signed by the therapist or by the attending physician. The physician may change a plan of treatment established by the occupational therapist. However, the occupational therapist may not alter a plan of treatment established by a physician.
Occupational Therapy availability – Two or more disciplines may provide therapy services to the same patient. There may also be occasions where these services are duplicative. In many instances, the description of the services appears duplicative, but the documentation proves that they are not. Some examples where there is not a duplication include:
Transfers – PT instructs the patient in transfers to achieve the level of safety with the techniques. OT utilizes transfers as they relate to the performance of daily living skills (e.g., transfer from wheelchair to bathtub.).

Pulmonary – PT instructs the patient in an adapted breathing technique. OT carries the breathing retraining into activities of daily living.

Hip Fractures/Arthroplasties – PT instructs the patient in hip precautions and gait training. OT reinforces the training with precautions for activities of daily living, e.g., lower extremity dressing, toileting and bathing.

CVA – PT utilizes upper extremity neurodevelopmental (NDT) techniques to assist the patient in positioning the upper extremities on a walker and in gait training. OT utilizes NDT techniques to increase the functional use of the upper extremity for dressing, bathing, grooming, etc.
Focused MR Analysis – The HCFA edits may assist you in identifying OT claims for focused MR. Perform regular evaluations of provider claims which pass or fail the edits.

Change your focused review claims selection based on the results of the evaluation. For example, a provider billing at an aberrantly consistent rate just below the edit parameters is subject to intensified review.

Develop procedures for focused MR based on each of the following trends or characteristics:

Edits with high charges per aggregate bill charges;

Providers billing a higher than average utilization of specific diagnostic codes that fall just below the edit parameters; and

Specific principal DX codes, such as those with longer visits and duration; those representing the most frequent denials in pre-pay MR; special codes, e.g., 585 Chronic Renal Failure; 733.1, Senile Osteoporosis; and 290.0-290.9, Senile and Presenile Organic Psychotic Condition; and/or certain edit groups such as `17, 19, and 29 in one quarter and others in the next quarter.
Occupational Therapy Code of Ethics

The American Occupational Therapy Association

OCCUPATIONAL THERAPY CODE OF ETHICS
The American Occupational Therapy Association’s Code of Ethics is a public statement of the values and principles used in promoting and maintaining high standards of behavior in occupational therapy. The American Occupational Therapy Association and its members are committed to furthering people’s ability to function within their total environment. To this end, occupational therapy personnel provide services for individ­uals in any stage of health and illness, to institutions, to other professionals and colleagues, to students, and to the general public.
The Occupational Therapy Code of Ethics, is a set of principles that applies to occupat­ional therapy personnel at all levels. The roles of practitioner (registered occupational therapist and certified occupational therapy assistant), educator, fieldwork educator, supervisor, administrator, consultant, fieldwork coordinator, faculty program director, researcher/scholar, entrepreneur, student, support staff, and occupational therapy aide are assumed.
Any action that is in violation of the spirit and purpose of this Code shall be considered unethical. To ensure compliance with the Code, enforcement procedures are established and maintained by the Commission on Standards and Ethics. Acceptance of membership in the American Occupational Therapy Association commits members to adherence to the Code of Ethics and its enforcement procedures.
Principle 1. Occupational therapy personnel shall demonstrate a concern for the

well-being of the recipients of their services. (beneficence)
A. Occupational therapy personnel shall provide services in an equitable manner for all individuals.

Occupational therapy personnel shall maintain relationships that do not exploit the recipient of services sexually, physically, emotionally, financially, socially or in any other manner. Occupational therapy personnel shall avoid those relationships or activities that interfere with professional judgment and objectivity.
Occupational therapy personnel shall take all reasonable precautions to avoid harm to the recipient of services or to his or her property.
Occupational therapy personnel shall strive to ensure that fees are fair, reasonable, and commensurate with the service performed and are set with due regard for the service recipient’s ability to pay.
Principle 2. Occupational therapy personnel shall respect the rights of the recipients of their services. (e.g., autonomy, privacy, confidentiality)

Occupational therapy personnel shall collaborate with service recipients or their surrogate(s) in determining goals and priorities throughout the intervention process.
Occupational therapy personnel shall fully inform the service recipients of the nature, risk, and potential outcomes of any interventions.
Occupational therapy personnel shall obtain informed consent from subjects involved in research activities indicating they have been fully advised of the potential risks and outcomes.
Occupational therapy personnel shall respect the individual’s right to refuse professional services or involvement in research or educational activities.
Occupational therapy personnel shall protect the confidential nature of information gained from educational, practice, research, and investigational activities.
Principle 3. Occupational therapy personnel shall achieve and continually maintain high standards of competence. (duties)

Occupational therapy practitioners shall hold the appropriate national and state credentials for providing services.
Occupational therapy personnel shall use procedures that conform to the Standards of Practice of the American Occupational Therapy Association.
Occupational therapy personnel shall take responsibility for maintaining competence by participating in professional development and educational activities.
Occupational therapy personnel shall perform their duties on the basis of accurate and current information.
Occupational therapy practitioners shall protect service recipients by ensuring that duties assumed by or assigned to other occupational therapy personnel are commensurate with their qualifications and experience.
Occupational therapy practitioners shall provide appropriate supervision to individuals for whom the practitioners have supervisory responsibility.
Occupation therapists shall refer recipients to other service providers or consult with other service providers when additional knowledge and expertise are required.
Principle 4. Occupational therapy personnel shall comply with laws and Association policies guiding the profession of occupational therapy. (justice)

Occupational therapy personnel shall understand and abide by applicable Association policies; local, state, and federal laws; and institutional rules.
Occupational therapy personnel shall inform employers, employees, and colleagues about those laws and Association policies that apply to the profession of occupational therapy.
Occupational therapy practitioners shall require those they supervise in occupational therapy related activities to adhere to the Code of Ethics.
Occupational therapy personnel shall accurately record and report all information related to professional activities.
Principle 5. Occupational therapy personnel shall provide accurate information about occupational therapy services. (veracity)
A. Occupational therapy personnel shall accurately represent their qualifications, education, experience, training, and competence.

Occupational therapy personnel shall disclose any affiliations that may pose a conflict of interest.
Occupational therapy personnel shall refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, or unfair statements or claims.
Principle 6. Occupational therapy personnel shall treat colleagues and other professionals with fairness, discretion, and integrity. (fidelity, veracity)

Occupational therapy personnel shall safeguard confidential information about colleagues and staff.
Occupational therapy personnel shall accurately represent the qualifications, view, contributions, and findings of colleagues.
Occupational therapy personnel shall report any breaches of the Code of Ethics to the appropriate authority.

Author:

Commission on Standards and Ethics (SEC)

Ruth Hansen, PhD, OTR, FAOTA, Chairperson

Approved by the Representative Assembly: 4/77

Revised: 1979, 1988, 1994

Adopted by the Representative Assembly: 7/94

NOTE: This document replaces the 1988 Occupational Therapy Code of Ethics which was rescinded by the 1994 Representative Assembly.

Core Values and Attitudes of Occupational Therapy Practice
Introduction

In 1985, the American Occupational Therapy Association (AOTA) funded the Professional the Technical Role Analysis Study (PATRA). This study had two purposes: to delineate the entry-level practice of OTRs and COTAs through a role analysis and to conduct a task inventory of what practitioners actually do. Knowledge, skills, and attitude statements were to be developed to provide a basis for the role analysis. The PATRA study completed the knowledge and skills statements. The Executive Board subsequently charged Standards and Ethics Commission (SEC) to develop a statement that would describe the attitudes and values that undergird the profession of occupational therapy. The SEC wrote this document for use by AOTA members.

The list of terms used in this statement was originally constructed by the American Association of Colleges of Nursing (AACN) (1986). The PATRA committee analyzed the knowledge statements that the committee had written and selected those terms from the AACN list that best identified the values and attitudes of our profession. This list of terms was then forwarded to SEC by the PATRA Committee to use as the basis for the Core Values and Attitudes paper.

The development of this document is predicated on the assumption that the values of occupational therapy are evident in the official documents of the American Occupational Therapy Association. The official documents that were examined are: (a) Dictionary Definition of Occupational Therapy (AOTA, 1986), (b) The Philosophical Base of Occupational Therapy (AOTA, 1979), (c) Essentials and Guidelines for an Accredited Educational Program for the Occupational Therapist (AOTA, 1991a), (d) Essentials and Guidelines for an Accredited Educational Program for the Occupational Therapy Assistant (AOTA, 1991b), and (e) Occupational Therapy Code of Ethics (AOTA, 1988). It is further assumed that these documents are representative of the values and beliefs reflected in other occupational therapy literature.

A value is defined as a belief or an ideal to which an individual is committed. Values are an important part of the base or foundation of a profession. Ideally, these values are embraced by all members of the profession and are reflected in the members’ interactions with those persons receiving services, colleagues, and the society at large. Values have a central role in a profession and are developed and reinforced throughout an individual’s life as a student and as a professional.

Actions and attitudes reflect the values of the individual. An attitude is the disposition to respond positively or negatively toward an object, person, concept, or situation. Thus, there is an assumption that all professional actions and interactions are rooted in certain core values and beliefs.

Seven Core Concepts

In this document, the core values and attitudes of occupational therapy are organized around seven basic concepts–altruism, equality, freedom, justice, dignity, truth, and prudence. How these core values and attitudes are expressed and implemented by occupational therapy practitioners may vary depending upon the environments and situations in which professional activity occurs.

Altruism is the unselfish concern for the welfare of others. This concept is reflected in actions and attitudes of commitment, caring, dedication, responsiveness, and understanding.

Equality requires that all individuals be perceived as having the same fundamental human rights and opportunities. This value is demonstrated by an attitude of fairness and impartiality. We believe that we should respect all individuals, keeping in mind that they may have values, beliefs, or life-styles that are different from our own. Equality is practiced in the broad professional arena, but is particularly important in day-to-day interactions with those individuals receiving occupational therapy services.

Freedom allows the individual to exercise choice and to demonstrate independence, initiative, and self-direction. There is a need for all individuals to find a balance between autonomy and societal membership that is reflected in the choice of various patterns of interdependence with the human and nonhuman environment. We believe that individuals are internally and externally motivated toward action in a continuous process of adaptation throughout the life span. Purposeful activity plays a major role in developing and exercising self-direction, initiative, interdependence, and relatedness to the world. Activities verify the individual’s ability to adapt, and they establish a satisfying balance between autonomy and societal membership. As professionals, we affirm the freedom of choice for each individual to pursue goals that have personal and social meaning.

Justice places value on the upholding of such moral and legal principles as fairness, equity, truthfulness, and objectivity. This means we aspire to provide occupational therapy services for all individuals who are in need of these services and that we will maintain a goal-directed and objective relationship with all those served. Practitioners must be knowledgeable about and have respect for the legal rights of individuals receiving occupational therapy services. In addition, the occupational therapy practitioner must understand and abide by the local, state, and federal laws governing the professional practice.

Dignity emphasizes the importance of valuing the inherent worth and uniqueness of each person. This value is demonstrated by an attitude of empathy and respect for self and others. We believe that each individual is a unique combination of biologic endowment, sociocultural heritage, and life experiences. We view human beings holistically, respecting the unique interaction of the mind, body, and physical and social environment. We believe that dignity is nurtured and grows from the sense of competence and self-worth that is integrally linked to the person’s ability to perform valued and relevant activities. In occupational therapy we emphasize the importance of dignity by helping the individual build on his or her unique attributes and resources.

Truth requires that we be faithful to facts and reality. Truthfulness or veracity is demonstrated by being accountable, honest, forthright, accurate, and authentic in our attitudes and actions. There is an obligation to be truthful with ourselves, those who receive services, colleagues, and society. One way that this is exhibited is through maintaining and upgrading professional competence. This happens, in part, through an unfaltering commitment to inquiry and learning, to self-understanding, and to the development of an interpersonal competence.

Prudence is the ability to govern and discipline oneself through the use of reason. To be prudent is to value judiciousness, discretion, vigilance, moderation, care, and circumspection in the management of one’s affairs, to temper extremes, make judgments, and respond on the basis of intelligent reflection and rational thought.

Summary

Beliefs and values are those intrinsic concepts that under lie the core of the profession and the professional interactions of each practitioner. These values describe the profession’s philosophy and provide the basis for defining purpose. The emphasis or priority that is given to each value may change as one’s professional career evolves and as the unique characteristics of a situation unfold. This evolution of values is developmental in nature. Although we have basic values that cannot be violated, the degree to which certain values will take priority at a given time is influenced by the specifics of a situation and the environment in which it occurs. In one instance dignity may be a higher priority than truth; in another prudence may be chosen over freedom. As we process information and make decisions, the weight of the values that we hold may change. The practitioner faces dilemmas because of conflicting values and is required to engage in thoughtful deliberation to determine where the priority lies in a given situation.

The challenge for us all is to know our values, be able to make reasoned choices in situations of conflict, and be able to clearly articulate and defend our choices. At the same time, it is important that all members of the profession be committed to a set of common values. This mutual commitment to a set of beliefs and principles that govern our practice can provide a basis for clarifying expectations between the recipient and the provider of services. Shared values empowers the profession and, in addition, builds trust among ourselves and with others.

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References

American Association of Colleges of Nursing (1986). Essentials of College and University Education for Professional Nursing. Final report. Washington, DC: Author.

American Occupational Therapy Association. (1979). Resolution C, 531-79: The philosophical base of occupational therapy. American Journal of Occupational Therapy, 33, 785.

American Occupational Therapy Association (1986, April). Dictionary definition of occupational therapy. Adopted and approved by the Representative Assembly to fulfill Resolution #596-83. (Available form AOTA, 1383 Piccard Drive, PO Box 1725, Rockville, MD 20849-1725.)

American Occupational Therapy Association. (1988). Occupational therapy code of ethics. American Journal of Occupational Therapy, 42, 795-796.

American Occupational Therapy Association. (1991a). Essentials and guidelines for an accredited educational program for the occupational therapist. American Journal of Occupational Therapy, 45, 1077-1084.

American Occupational Therapy Association. (1991b). Essentials and guidelines for an accredited educational program for the occupational therapy assistant. American Journal of Occupational Therapy, 45, 1085-1092.

Prepared by Elizabeth Kanny, MA, OTR, for the Standards and Ethics Commission (Ruth A. Hansen, PhD, OTR, FAOTA, Chairperson).
Approved by the Representative Assembly June 1993.