The Importance of Outcome Assessments
One of the many benefits of being an ICS member is staying current on changes in documentation and billing rules. We have informed our members regarding PQRS and modifier -59 already this year. I would like to remind everyone about the importance of Outcome Assessments and their use in our practices every day. If used correctly, outcome assessments will help you document functional improvement.
The most commonly used outcome assessment indexes are the Neck Disability Index and the Revised Oswestry Back Index. Although there are other indexes available, Medicare requires an assessment tool that has been appropriately normalized and validated for the population in which it is used. The ACA has identified examples of tools for the functional outcome assessment measure to include, but not be limited to: “Oswestry Disability Index (ODI), Roland Morris Disability/Activity Questionnaire (RM), Neck Disability Index (NDI), Physical Mobility Scale (PMS), Patient-Reported Outcomes Measurement Information System (PROMIS), Disabilities of the Arm, Shoulder and Hand (DASH), and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL).”
In my office, I have the patient complete an outcomes assessment index for each regional complaint, and I document the result as a percentage. I repeat the indexes at the 6th visit because there are treatment guidelines that state functional improvement needs to be documented by the 6th visit. I also repeat the indexes on the 12th visit or with each re-exam, again to document functional improvement. If a patient’s index score increases, I make sure I document the reason. For example: if the score increases due to exacerbation, the specific exacerbation should be documented. Also, repeat the indexes with each exacerbation, and do a re-exam even if the visit count is less than 12. Don’t forget to document clearly how the index scores affect future treatment.
If you are asked to send records in for a review, you should send in a copy of the actual outcomes assessment form the claimant completed.
Outcome assessments are required by Medicare and recommended by several other managed care companies, and they are highly recommended in worker’s compensation and personal injury cases. They are critical to our overall documentation story and should be utilized regularly in every office.