Co-Treating in Occupational Therapy: When is it Appropriate?

As an occupational therapist, you often have patients that are best treated with more than one person (also known as co-treating).

The big question is: Should the second person be the nurse, a tech, or a physical therapist?

The following will help guide your decision-making process to decide if a patient would be best served with a co-treatment or not.

Important Considerations to Make 

The first consideration is whether or not a second person is required to assist with the treatment.

Ask yourself, what are the goals of the treatment? Specifically, what exercises or activities will this patient need to work on today to help them reach their goals?

If the goal is to improve bed mobility in order to allow the patient to don their pants in bed – and this requires the assistance of two people – a tech or an aide may be the most appropriate choice.

A patient that requires the assistance of two people to roll in bed is likely on a turning schedule, so the nurse or tech would be assisting with bed mobility anyway. However, if the patient’s physical therapist is also working on bed mobility, it may be appropriate to co-treat to increase strength and function (for example).

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Does the Other Therapist Have Different Goals?

If the physical therapist does not have goals related to the same activity as the occupational therapist (bed mobility in this case), then it would not be appropriate to co-treat. In this situation, the second person should either be the nurse or a tech. If the treatment could be performed by only one therapist then co-treatment would not be appropriate.

If the patient could be taught how to use a bed rail and push with their leg to roll with only one therapist, then a co-treatment would not be necessary.

When Goals Overlap

Sometimes goals not only overlap but are complementary, and a better result can be obtained through a co-treatment.

Consider an instance where the patient completes both physical tasks and comprehension and memory tasks well if they are completed separately. However, the patient has difficulty completing cognitive tasks at the same time as completing mobility tasks.

These types of dual task activities are necessary to complete higher-level activities such as grocery shopping. In this case, it may be beneficial to the patient to co-treat with speech therapy to progress the patient’s therapy program and allow them to fully meet goals.

Another example often seen in acute care involves a physical therapist that has a goal for a lower-level patient to sit edge of bed with good sitting balance; the occupational therapist has a goal to complete grooming tasks or upper body ADLs seated edge of bed. This may be a good time for OT to incorporate upper body ADL retraining while the PT addresses sitting balance.

Billing Concerns for Co-Treatment

Typically in an inpatient rehab setting, billed units will need to be split between co-treating therapists.

For example, if an OT co-treats a patient with physical therapy for 45 minutes, the OT and the PT can only charge a sum total of 3 units. Most likely, one person will charge 2 units and the other will charge 1 unit and two non-billable units, depending on if the setting incorporates non-billables. This rule applies in any setting where Medicare Part B is the payer source.

Rehab units also require that a patient be seen for 3 hours of therapy a day. Co-treating a patient can make it difficult to meet this requirement. If co-treating the patient will make it impossible to meet the patient’s requirement for hours of therapy for the day, then it may be most appropriate to use a tech or aide as the second person.

This requirement is generally not a concern on an acute care unit (depending on the facility’s guidelines). If the payment source is Medicare Part A, generally when a patient is on a skilled nursing unit or on an acute unit, each therapist can bill separately, and units will not need to be split. In this example, a patient who was co-treated by both physical therapy and occupational therapy for 30 minutes on a skilled nursing unit can each bill 2 units.

The first concern that should be considered when making the decision to co-treat or not should always be: What is most beneficial to the patient?

Will the treatment be most effective if two skilled therapists from separate disciplines are present? Will the patient’s safety be compromised in any way if two therapists are not present? If the answer to either of these two questions is yes, then co-treatment is the best option.

Remember that billing rules are subject to change at any time. Always check with your manager about the most current policies at your place of work.

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Other Reasons to Co-treat

Occasionally, an evaluation needs to be done by a certain time period for both disciplines (such as in acute care) and the only time each separate discipline has to do it coincides. In this case, if co-treatment will not impede the patient’s progress in any way, it may be the best (or only) choice.

It is also common for a patient needing the skills of two people to complete mobility tasks safely. If a nurse or a tech is not available, the best option to complete the treatment safely may be co-treating. It is especially important in these cases to document the separate goals that each discipline is focusing on, such as incorporating ADL retraining during sitting or standing balance activities.

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In an ideal world, the decision to co-treat or not will always be based on whether or not the co-treatment is beneficial and necessary to the patient. If it will help the patient reach their goals more quickly, it is usually the best option.

For more information about co-treatments, be sure to check out the resources listed below.

 

Further Readings and Resources

The Rehab Therapist’s Guide to Co-Treatment Under Medicare (WebPT)

Therapy Co-Treatment Scenarios and Documentation (Harmony Healthcare)

Clinical Indications for Co-Treatment (Kindred Rehab)

 

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