Functional Goal Writing - Interactive Metronome

Writing Functional Goals Linking IM Goals to Functional Deficits

Sample Goals: Stroke & TBI

  Patient will bear weight on non-affected side in standing with moderate assistance for balance and shift weight onto affected side 25/50 repetitions (50% accuracy) in 2 minutes.

  Patient will be able to reach while maintaining a 90 degree position of the affected side on supine with 25/50 repetitions (50% accuracy) in 2 minutes and moderate assistance for success.

  Patient will be able to shift weight onto affected side with 30/50 attempts (60% accuracy) in 2 minutes and minimal assistance in parallel bars.

Diagnosis & CPT Codes Stroke & TBI

  97110 Therapeutic Exercise - ortho, coordination and endurance   97530 Therapeutic Activity - therapeutic activities and work simulation   97112 Neuromuscular Reeducation - Nerve injuries (UMN and LMN)

  342.00 Hemiplegia flaccid   CPT codes: 97110, 97530, 97112

  342.10 Hemiplegia spastic   CPT codes: 97110, 97530, 97112

  438 Cerebral Vascular Event (Late Effects)   CPT codes: 97110, 97530, 97112

  432.1 Subdural Hemorrhage   CPT codes: 97110, 97530, 97112

Sample Goals: LMN Rehab   Patient will perform median nerve

innervated thumb adduction repetitive movement activity 30/50 attempts (60% accuracy) in 2 minutes and visual cues for assistance with enough strength to close a switch without stopping.

  Patient will be able to step up on 6 inch step without foot drop with good placement performing the activity with 35/50 repetitions(70 % accuracy) in 2 minutes with moderate assistance for balance and attention.

Diagnosis & CPT Codes LMN Rehab


  354.0 Carpal Tunnel Syndrome   97110, 97530, 97112

  354.3 Injury of the radial nerve   97110, 97530, 97112

  354.2 Injury of the ulna nerve   97110, 97530, 97112

  353.0 Brachial plexus injury   97110, 97530, 97112

  724.3 Sciatica   97110, 97530, 97112

Sample Goals: Shoulder Rehab

  Patient will achieve 90 degrees of right shoulder abduction with moderate assistance and verbal cuing for performance 25/50 repetitions (50% accuracy) in 1 minute, as needed to feed him/herself independently.

  Patient will be able to perform right scapula elevation, retraction and depression while slowing down and speeding up with minimal cuing 25/50 repetitions (50% accuracy) in 1 minute to facilitate optimum scapulothoracic rhythm required for shoulder elevation.

  Patient will be able to achieve 60 degrees of shoulder flexion during repetitive task practice with feedback based activities 6/10 repetitions with reports of shoulder pain no greater than 2/10 with no delayed onset of pain due to capsulitis.

Diagnosis & CPT Codes Shoulder Rehab


  727.61 Rotator Cuff Tear (Complete)   97110

  726.0 Adhesive Capsulitis   97110

  719.41 Shoulder Pain   97110, 97530

Sample Goals: Elbow Rehab   Patient will perform a functional

reach activity requiring negative 10 degrees of elbow extension 35/50 repetitions (70% accuracy) in 2 minutes with min assistance for success.

  Patient will perform a rhythmical coordinated elbow flexion and extension activity 35/50 repetitions (70% accuracy) and moderate assistance for success requiring 50 degrees of movement from flexion to extension.

Diagnosis & CPT Codes Elbow Rehab


  832.01 Dislocation of Elbow   97110

  726.32 Lateral Epicondylitis   97110, 97530

  927.11 Crush injury to elbow   97110, 97530

Sample Goals: Hand Rehab

  Patient will be able to achieve a full right hand fist while performing a repetitive movement activity with 25/50 repetitions(50% accuracy) in 2 minutes and moderate assistance for success with minimal fatigue.

  Patient will perform a thumb and four finger tap activity on the table in a syncronized repetitive pattern 35/50 repetitions (70% accuracy) in 2 minutes to improve his/her ability to return to playing the piano.

Diagnosis & CPT Codes Hand Rehab


  736.06 Claw hand (Acquired)   97110, 97530

  816 Fracture of the Hand   97110, 97530

  715.04 Osteoarthritis affecting the hand   97110, 97530

  719.54 Stiffness of the hand   97110

Sample Goals: Functional Movement

  Patient will reach across midline while lying supine 25/50 repetitions (50% accuracy) for 2 minutes in order to increase trunk flexion and rotation required to roll from supine to side lying.

  Patient will be seated on mat and utilize lateral trunk flexion to lower (right or left) forearm onto mat 10/20 repetitions (50% accuracy) with moderate assistance for success in order to improve strength and motor coordination when moving from side lying to/from sitting.

Sample Goals : Functional Movement

Cont.   Patient will stand and perform a “mini-squat” 35/50 repetitions

(70 % accuracy) in 2 minutes and minimal assistance in order to improve anterior weight shift required to move from standing to sitting.

  Patient will maintain midline trunk control, hip, and knee control when standing on (right or left) leg and performing a toe tapping activity (tapping on a 3” block for 2 minutes) with 25/50 repetitions (50% accuracy) and moderate assistance for balance in order to increase strength and motor control in unilateral stance.

Diagnosis & CPT Codes Functional Movement

•  97110 Therapeutic Exercise •  97112 Neuromuscular Reeducation

 Needs ICD-9 Codes for this slide!  See Slide 14 for example

Sample Goals: Neuro Rehab

  Patient will complete reciprocal bilateral integration exercises 35/50 repetitions (70% accuracy) within 2 minutes with increased spontaneous initiation of UB/LB positioning and timing during sit to stand transitions.

  Patient will complete bed to bedside commode transfers 7/10 attempts (70% accuracy) in 1 minute for improved safety with transfers.

  Patient will increase bilateral upper extremity integration sufficient to bring both hands to midline 35/50 repetitions (70% accuracy) in 1 minute in order to increase I in ADL's

CPT Codes: Neuro Rehab

•  97530 - Therapeutic Activity •  97110 - Therapeutic Exercise •  97112 - Neuromuscular Reeducation •  97140 - Manual Therapy •  97532 - Cognitive Skills Development

 Needs ICD-9 Diagnosis codes  See Slide 14

Sample Goals: Parkinsons

  Reduce physical assistance to supervision level for 10/20 repetitions sit to stand transitions in 1 minute using rhythmic cues over 3 consecutive sessions.

  Maintain static standing balance without external support while performing bilateral hand clapping exercises for 5 minutes

Diagnosis & CPT Codes: Parkinsons

•  97110 Therapeutic Procedure •  97112 Neuromuscular Reeducation •  97535 ADL Self Home Management •  97530 Therapeutic Activity

 Needs ICD-9 codes  See Slide 14

Documentation of Treatment Session

Treatment Notes: Patient seen for skilled PT services for _____ mins _____ TA/TEX. Patient instructed in motor control pattern for toe tapping on a 6 inch platform (dynamic balance practice) in a repetitive, synchronous pattern with auditory feedback in preparation for navigating stairs. Patient required bilateral hand rails and a gate belt to maintain balance. Required a five-second rest periods X 4 in 2 minutes due to low endurance. Required verbal cues to sequence and maintain left / right weight shifting. Patient's husband present during treatment to observe and receive hands-on education to assist with facilitating ADL's. Patient had no complaints of pain during treatment.

Documentation of Treatment Session

Treatment Notes: Patient seen for skilled OT services for _____ mins _____ TA/TEX. Patient instructed in motor control patterns to address bringing bilateral hands to midline in synchrony to a repetitive auditory stimulus in preparation for following basic 2-3 step verbal directions during UB dressing activities. Patient requiring hand over hand assist to sequence and maintain left / right UE with decreased tone and increased fluidity of motor control following treatment. Patient's husband present during treatment to observe and receive hands-on education to assist with facilitating ADL's.

Sample Goals: Cognitive Impairment

  Patient will demonstrate sustained & accurate visual attention and processing in order to complete a task with 35/50 repetitions ( 70% accuracy) within 2 minute in order to complete daily tasks in the home safely and independently.

  Patient will demonstrate sustained visual attention to task in the presence of visual distractions with fewer than 5 errors in 2 minutes over 3 consecutive tasks in order to complete daily tasks in the home safely and independently.


Cont.   Patient will demonstrate sustained visual attention to task,

timely visual processing, & impulse-control with fewer than 5 errors in a 2 minute time period over 3 consecutive tasks in order to locate items when grocery shopping independently & timely.

  Patient will demonstrate sustained visual attention to task, timely visual processing, working memory & anticipation/planning with fewer than 3 errors in a 3 minute time period over 3 consecutive tasks in order to complete functional tasks in the home independently & safely.


Cont.   Patient will demonstrate timely processing, cognitive flexibility, and

anticipation/planning with fewer than 5 errors in a 3 minute time period over 3 consecutive tasks in order to perform IADLs.

  Patient will demonstrate sustained attention to task, self-monitoring, & self-correction during a cognitive-motor task with fewer than 3 errors in a 3 minute time period over 3 consecutive tasks in order to perform IADLs.

Sample Goals: Speech/Language Deficit

  Patient will demonstrate improved naming and word finding skills by naming items from an array of 25 pictures with 25/50 repetitions (50% accuracy or 5 errors in a 2 minute time period) and moderate cues for success in order to communicate basic wants and needs in a home environment.

  Patient will demonstrate improved receptive language skills by identifying a symbol, photo, or object by touching or selecting that symbol, photo, or object in a field of 10 with 50% accuracy or no more than 5 errors in 2 minutes) and moderate cues for success in order to communicate within their home environment.


  Patient will demonstrate improved speech intelligibility by performing minimal pair task practice at 25/50 repetitions (50% accuracy) in 2 minutes and moderate cues in order to communicate basic wants and needs in a home environment.

  Patient will demonstrate improved speech intelligibility by reciting poems, rhymes, Melodic Intonation, and songs at 50% accuracy and moderate cues in order to communicate within their home environment.


  Patient will demonstrate improved receptive language and auditory comprehension skills by following a 2 step direction with 25/50 repetitions in 2 minutes (50% accuracy) and moderate cues in order to complete basic ADL’s.

  Patient will demonstrate improved receptive language and auditory comprehension skills by indicating yes/no in response to moderately complex questions at 25/50 responses in 2 minutes (50% accuracy) and moderate cues in order to communicate wants and needs within their home environment.

Speech Therapy Documentation Example

Soap Note Example: •  S – Patient seen for skilled speech therapy. He was alert and

oriented. He participated well in treatment and had no complaints of pain.

•  O – Patient will follow a 2-step direction •  A – Followed a 2-step direction in the presence of auditory cues

and repetitive task practice with hand over hand assistance. Required more assistance from clinician as complexity of auditory cue and feedback was added. Has difficulty in distraction. Required moderate assistance to persist.

•  P – Increase complexity of feedback, reduce amount of clinical assistance require. Alternate between two different sets of directions as tolerated.

Diagnosis & CPT Codes Cognitive Impairment & Speech/Language Deficit

  92507 – Speech Therapy - Treatment of speech, language, voice, communication, and/or auditory processing disorder;

  97532 – Cognitive Skills Development - Development of cognitive skills to improve attention, memory, problem solving

  438.0 Late effects of cerebrovascular disease   438.10 Late effects of cerebrovascular disease - speech and

language deficits   438.11 Late effects of cerebrovascular disease – aphasia   438.13 Dysarthria   438.14 Fluency disorder

Stuttering   438.82 Late effects of cerebrovascular disease – apraxia

Diagnosis & CPT Codes Cognitive Impairment & Speech/Language Deficit

Cont   92507 – Speech Therapy - Treatment of speech, language, voice,

communication, and/or auditory processing disorder;   97532 – Cognitive Skills Development - Development of cognitive

skills to improve attention, memory, problem solving

  784.3 Aphasia   784.5 Other speech disturbance   784.51 Dysarthria   784.59 Other speech disturbance

Dysphasia Slurred speech Speech disturbance NOS

Coding Considerations for SLP’s

Question: I work in a skilled nursing facility. When I provide services for a patient who communicates functionally but has impairment(s) in orientation, memory, attention or problem solving, I bill that as 97532. If the patient has dysarthria, apraxia, aphasia, or voice difficulties, I bill that as 92507. I travel to different buildings and see these codes used interchangeably amongst different SLPs. Some buildings do not want to take the chance on a cognitive treatment denial, so they strongly encourage their SLPs to utilize the language code. Please advise on when to appropriately use each code.

Coding Considerations for SLP’s

Answer: Selecting the correct CPT code to describe a service provided is guided by several general principles: (1) Any code in the CPT manual can be used by any professional, as long as it is within their scope of practice; (2) That said, certain payors (like Medicare) can decide they won't reimburse for a specific code; (3) sometimes two codes may equally accurately describe the service rendered. If a payor has said it won't pay for a specific service, then the clinician can see if another code (that is reimbursed) still accurately describes what was done. Many Medicare Fiscal Intermediaries (FIs) have said SLPs can't use the Cognitive Retraining Code (97532). Medicare has also indicated it considers 92507 as an "umbrella" code that covers everything SLPs do. To answer your specific question, I think your interpretation of the difference in cognitive retraining vs. speech-language treatment is exactly how I would interpret it. You can find out if your Medicare FI will pay for SLPs performing cognitive retraining by reading the Local Coverage Determination (LCD). Your facilities should have copies of these documents. If your FI will not pay SLPs to perform cognitive therapy, then 92507 is an accurate choice as well.

http://www.speechpathology.com/askexpert/display_question.asp?question_id=361

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Functional Goal Writing - Interactive Metronome