Page 197 - Medicare Benefit Policy Manual

respiratory therapy, social services, psychology, nutritional/dietetic
services, radiation therapy, chemotherapy, etc.), and/ or

o Identification of durable medical equipment needed for this condition,
and/or

o Identification of the number of medications the beneficiary is taking
(and type if known); and/or

o If complicating factors (complexities) affect treatment, describe why
or how. For example: Cardiac dysrhythmia is not a condition for
which a therapist would directly treat a patient, but in some patients
such dysrhythmias may so directly and significantly affect the pace of
progress in treatment for other conditions as to require an exception to
caps for necessary services. Documentation should indicate how the
progress was affected by the complexity. Or, the severity of the
patient’s condition as reported on a functional measurement tool may
be so great as to suggest extended treatment is anticipated; and/or

o Generalized or multiple conditions. The beneficiary has, in addition to
the primary condition being treated, another disease or condition being
treated, or generalized musculoskeletal conditions, or conditions
affecting multiple sites and these conditions will directly and
significantly impact the rate of recovery; and/or.

o Mental or cognitive disorder. The beneficiary has a mental or
cognitive disorder in addition to the condition being treated that will
directly and significantly impact the rate of recovery; and/or.

o Identification of factors that impact severity including e.g., age, time
since onset, cause of the condition, stability of symptoms, how
typical/atypical are the symptoms of the diagnosed condition,
availability of an intervention/treatment known to be effective,
predictability of progress.

Documentation supporting medical care prior to the current episode, if any,
(or document none) including, e.g.,

o Record of discharge from a Part A qualifying inpatient, SNF, or home
health episode within 30 days of the onset of this outpatient therapy
episode, or

o Identification of whether beneficiary was treated for this same
condition previously by the same therapy discipline (regardless of
where prior services were furnished; and