• News New Blog Banner

  • Additional Functional Limitation Reporting Case Scenarios Now Available

    APTA has created 4 additional case scenarios to help physical therapists comply with functional limitation reporting requirements under Medicare. Each scenario includes a description of the patient and data and documentation requirements that physical therapists must meet at the initial evaluation, 10th visit, and discharge. Examples of charge forms for the 3 visits and a summary of reporting also are available for each scenario.

    The new scenarios are: multiple sclerosis, establishing a maintenance plan/no function change; diabetic foot ulcer, functional limitations; diabetic foot ulcer, no limitation; and neck pain.

    More case scenarios will be posted in the near future.

    Functional limitation reporting on claim forms began January 1. A testing period is in effect until July 1. After July 1, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.


    • I would like to see some scenarios related to acute care patients in observation status. I would like to know which, if any, functional assessments you recommend for use in the acute setting with such patients as well. Examples of acute observation cases I would love see include: TIA with no deficits, UTI with a general decline in mobility, and a Rotator Cuff Repair referred for a one time treatment to teach pendulum exercises. Thank You.

      Posted by Bonnie Fakhri on 3/8/2013 12:45 PM

    • I agree with Bonnie's request regarding scenarios related to observation patients in acute care. In particular are we setting our goals for the immediate course of therapy which is to identify the next most appropirate level of care, or what their goal would be when they are done with that course of care which could occur in home care, OP, SNF, rehab, etc. Most patients we see one time and recommend a discharge setting. A few patients we may see twice in an attempt to get them to a level where they can go home. Thank you.

      Posted by Mary McLaughlin -> =OT[B on 3/8/2013 5:51 PM

    • In the newly added scenario for neck pain, why is there 8th day reporting rather than 10th day?

      Posted by Jo Brothers -> >GUcE on 3/9/2013 10:25 AM

    • The progress note is done at the 8th visit in the neck pain case; this is in compliance with Medicare regulations which require that the progress note be done at a minimum of every 10 visits.

      Posted by APTA Staff on 3/11/2013 9:27 AM

    • I would like to see some scenarios related to Pelvic Physical Therapy.

      Posted by Susan Shibley -> @LU\E on 3/13/2013 9:48 PM

    • I also woudl like some examples for the Observation patient. Some of the diagnoses we may see in observation are the results of falls, TIA, generalize malaise with change in mental status I really really appreciate the examples on the back and neck

      Posted by Nancy Morasso-Reger -> =JXZ< on 4/5/2013 4:11 PM

    • I would like to see some examples for lymph edema patients

      Posted by Patricia Martinez -> ALRaC on 4/18/2013 10:41 AM

    Leave a comment
    Name *
    Email *