Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being. And yes, its effectiveness is well-documented.
One year ago, 18-year-old Will Richards says he struggled to do much of anything active – endurance was too challenging. Then he started seeing a recreational therapist and now, Richards, who has autism, says his energy levels and enthusiasm for activity have improved significantly.
Marli VanLake, uses recreation and leisure activities like swimming to develop a goal-oriented therapy program tailored to his abilities and interests. “Every session he has definitely improved, and now that we are getting the muscles going, it’s less working on form and more on balance and core strength,” VanLake says. ”It’s been a real treat to see that [recreational therapy] has helped him improve.”
Karen Richards, Will’s mom, says her son’s improved endurance levels have affected him both physically and mentally. “It’s really changed his perspective,” she says.
While it’s only been a year, Will Richards says he’ll continue his sessions with VanLake, striving to reach for new goals: “I want to develop my muscles so I can do more, and I can be more self-dependent.” The American Therapeutic Recreation Association (ATRA) is the largest national membership organization representing the interests and needs of recreational therapists.
For billing purposes Therapeutic Rehabilitation is often merged into other services. This is generally the case when an Occupational Therapist is leading the service delivery and a Certified Recreational Therapist works under their guidance. Physical therapy is often a part of the care regimen in these instances.
Physicians/NPPs, independent physical therapists, and independent occupational therapists may bill for physical therapy services using the CPT physical medicine and rehabilitation codes. For evaluations/re-evaluations, physical therapists should use CPT code 97001 and CPT code 97002, and occupational therapists should use CPT code 97003 and CPT code 97004. For evaluation/re-evaluations physician/NPP should report the appropriate E&M code.
In other instances, especially outside of nursing and hospital facilities, where therapeutic recreation has been determined to be of benefit to a patient by their physician – often a PM&R physician – a general procedure code is used such as G0515. This is not uncommon in cases where Personal Injury Protection benefits are billed as is the case with worker’s compensation and auto no-fault policies. Providers work out a schedule of services as part of the Treatment Plan, generally providing the Therapeutic Recreation 3 to 5 times weekly which should be specified on any orders and subject to outcome evaluation. This applies when serving both adults and juveniles.
What is really important is ensuring that the supporting documentation for the service clearly identifies specific clinical needs and patient responses to the therapy, i.e. clinical outcomes. This validates the legitimacy of treatment and supports its need.
Even though Medicare does not require the service, it is not disallowed if believed to be of benefit. Note this CMS policy language: “We do not believe that they should replace the provision of these core skilled therapy services. Thus, we believe that it should be left to each individual IRF to determine whether offering recreational therapy, music therapy, or respiratory therapy is the best way to achieve the desired patient care outcomes. • While we are not adding these therapies to the list of required therapy services in IRFs, we do recognize that they are Medicare covered services in IRFs if the medical necessity is well documented by the rehabilitation physician in the medical record and is ordered by the rehabilitation physician as part of the overall plan of care for the patient. However, consistent with our longstanding policies and standard practices, these therapy activities are not used to demonstrate that a patient has received intensive therapy services.”
We support the value of this service and believe it can be a major catalyst to helping injured patients improve in activities of daily life and overall physical and cognitive function.
We would love to hear your thoughts.
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