How do I document and get paid for practicing Rehabilitative Tai Chi?
A: This question comes up in every training and rightfully so as constraints on the third party payer systems continue to tighten. Paradoxically I have found that since using Tai Chi as a primary rehabilitative tool in my own practice, money has flowed into my bank account with more ease and consistency. With that said, there are two basic ways we can approach this issue. The first is documenting for third party reimbursement and the second is enhancing avenues of cash based income.
Third Party Documentation
While documentation strategies like computer-based systems are changing how we do things, the basics of justifying our practices still boil down to identifying the problem, goal setting, employing specific treatments, and then coding the treatments to connect them all together. For instance, we determine our client is unable to abduct his/her shoulder above 90 degrees because of deltoid weakness, we then set a goal of 120 degrees shoulder abduction, choose to employ shoulder abduction exercises, and finally code 97110 Therapeutic Exercise to describe our reason for doing it. Nuances certainly exist and of course there is follow up testing;yet this basic structure can guide us for documentation and coding: problem, goal, solution, and reasoning/justification.
With this structure in mind we can successfully document for evidence based Tai Chi practices. Below are three common treatment codes which are supported in the Tai Chi research literature as effective treatment interventions.
97112 Neuromuscular Re-Education of Movement, Balance, Coordination: The clinician and/or patient perform activities to one or more body areas that facilitate reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception.
97110 Therapeutic Exercise: A manner of effecting change through the application of clinical skills and/or services that attempt to improve function, develop strength, endurance, range of motion, and flexibility
97530 Therapeutic Activities – Direct: The clinician uses dynamic therapeutic activities designed to achieve improved functional performance (e.g., lifting, pulling, bending).
Example:
1. Evaluation reveals that client has balance deficits resulting from hip weakness, core muscle incoordination, and sensory dysfunction.
2. Goal setting includes improving functional balance measures, hip muscle strength, trunk coordination, and sensation/proprioception.
3. Visit the IRQTC member’s area, download the “Target Areas” pdf, and find item lists including Hip Strength/ROM, diagonal stability, and gait training. Choose gestures that address goal areas.
4. Download the “Gesture Benefits” pdf to more specifically list the therapeutic benefits of each gesture.
Result:
97112 Neuromuscular Re-education. Rehabilitative Tai Chi: Cloud Hands stepping for gluteal/oblique/abdominal strengthening, lateral stability, midline crossing, and proprioceptive stimulation. 5 Steps each direction x 3
Cash Based Income
A 2009 report cited that Americans spend $34 billion annually on alternative medicine and this number continues to grow each year reflecting the inadequacies of the current western medical system. The most powerful changes in consumer based economies is driven by the consumers themselves, meaning if the consumer base wants something badly enough then eventually someone will figure out how to create the product or service to fill that need. Presently there is a strong trend towards Complimentary and Integrative Medicine (CAM) with major medical systems moving to create Yoga, Tai Chi, and Mindfulness based programs. In many cases however, instructors of these programs are trained primarily to interface with relatively healthy community based participants and aren’t trained in adaptive and modification techniques. Rehabilitation professionals are uniquely suited to fill this gap and treat client populations who desire CAM services yet are unable to access community based classes. In addition, there are a significant number of people who require skilled rehabilitation and simply prefer Body-Mind approaches. Even in relatively small communities, becoming an expert in CAM approaches like Tai Chi creates a substantial, lucrative, and rewarding cash based niche practice.
Do you have a question or something successful to announce? Share it with your IRQTC community and together let’s become the kind of therapists you would want to see if you needed help.
Be Well,
Brian
Originally published May 2015.