LCD for Inpatient Rehabilitation (L22951)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L22951 

 

LCD Title 

Inpatient Rehabilitation 

 

Contractor's Determination Number 

L22951 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

IOM 100-02 Chpt. 1 Section 110

110 - Inpatient Hospital Stays for Rehabilitation Care

110.1 - General

Physicians generally agree on the circumstances that justify a medical or surgical patient's hospitalization. In addition, in some cases an admission to a rehabilitation hospital or to the rehabilitation service of a short-term hospital can be justified on essentially the same medical or surgical grounds. In other cases, however, a patient's medical or surgical needs alone may not warrant inpatient hospital care, but hospitalization may nevertheless be necessary because of the patient's need for rehabilitative services.

Patients needing rehabilitative services require a hospital level of care, if they need a relatively intense rehabilitation program that requires a multidisciplinary coordinated team approach to upgrade their ability to function. [1] There are two basic requirements that must be met for inpatient hospital stays for rehabilitation care to be covered:

The services must be reasonable and necessary (in terms of efficacy, duration, frequency, and amount) for the treatment of the patient's condition; [2] and
It must be reasonable and necessary to furnish the care on an inpatient hospital basis, rather than in a less intensive facility such as a SNF, or on an outpatient basis. [3]

Medicare recognizes that determinations of whether hospital stays for rehabilitation services are reasonable and necessary must be based upon an assessment of each beneficiary's individual care needs. [4] Therefore, denials of services based on numerical utilization screens, diagnostic screens, diagnosis or specific treatment norms, "the three hour rule," or any other "rules of thumb," are not appropriate.

110.2 - Preadmission Screening

Before a patient is admitted to a rehabilitation hospital for treatment, a preadmission screening is normally done. This screening is a preliminary review of the patient's condition and previous medical record to determine if the patient is likely to benefit significantly from an intensive hospital program or extensive inpatient assessment.

While preadmission screening is a standard practice in most rehabilitation hospitals and may provide useful information for claims review purposes, the absence of preadmission screening in a particular case is not adequate reason for denying a claim. However, in a case where an inpatient assessment showed that a patient clearly was not a good candidate for an inpatient hospital program, then the presence or absence of preadmission screening information is important in determining whether the inpatient assessment itself was reasonable and necessary. If preadmission screening information indicated that the patient had the potential for benefiting from an inpatient hospital program, a period of inpatient assessment could be covered, up to the point where it was determined that inpatient hospital rehabilitation was not appropriate, since preadmission screening cannot be expected to eliminate all unsuitable candidates. [5]

110.2.1 - Admission Orders
42 CFR 412.606

At the time that each Medicare Part A fee-for-service patient is admitted, the inpatient rehabilitation facility must have physician orders for the patient's care during the time the patient is hospitalized.

110.3 - Inpatient Assessment of Individual's Status and Potential for Rehabilitation
CFR 412.606

Medicare Part A fee-for service beneficiaries in IRFs are assessed by a clinician using the CMS’ patient assessment instrument upon admission and at discharge. The CMS’ patient assessment instrument consists of nine sections, each to collect different categories of patient information. These categories include identification and demographic information about the patient, medical information, and information related to quality of care and basic patient safety. IRFs must computerize and electronically report the patient assessment data.

In general, the admission assessment must have an assessment reference date of day three of the IRF stay, be based upon observations done in the first three days of the IRF stay and be completed by day 4 of the IRF stay.

The discharge assessment must have an assessment reference date that is the actual day that one of two events occurs first: (1) the day on which the patient is discharged from the IRF; or (2) the day on which the patient dies. The discharge assessment is based upon observations done in the three calendar days prior to and including the assessment reference date on the discharge assessment. The discharge assessment must be completed by the 5th calendar day that follows the discharge assessment reference date with the discharge assessment reference date itself being counted as the first day of the five calendar day time period.

In certain cases, a beneficiary may have an interrupted stay that may affect the assessment reference dates, completion dates, and encoding date. An interrupted stay is defined as one in which an IRF patient is discharged from the IRF and returns to the same IRF within three consecutive calendar days that begins with the day of discharge and ends on midnight of the third day.

When a beneficiary has an interrupted stay, the interrupted stay must be documented on the assessment instrument. If the interruption is less than three calendar days, the IRF does not need to complete a new admission assessment. However, in those cases where the patient is discharged and returns after three consecutive calendar days, the IRF is required to complete a new admission assessment.

110.3.1 - General

Coverage is available for inpatient assessment of a patient's potential to benefit from an intensive coordinated rehabilitation program only if it was reasonable and necessary to perform the assessment in the hospital.[6] This determination is made on the basis of information available in the patient's medical record. It is important to note that the assessment process is not merely a paperwork review, but rather an onsite professional review of the patient's condition by the necessary disciplines. Inpatient assessments conducted by a rehabilitation team through examination of the patient usually require between 3 to 10 calendar days, but on occasion may require more. This 3 to 10 day period is often one where the patient is receiving therapies rather than simple screening assessments. Where more than 10 days are required, the case is carefully reviewed to ensure that such additional time was necessary. An inpatient assessment may be covered even if the assessment subsequently indicates that a patient is not suitable for an intensive inpatient hospital rehabilitation program, if the patient's condition on admission was such that an extensive inpatient assessment was considered reasonable and necessary for a final decision to be made on a patient's actual rehabilitation potential. Where the initial assessment has resulted in a conclusion that the individual is a poor candidate for rehabilitation care, coverage for further inpatient hospital care is limited to a reasonable number of days needed to permit appropriate placement of the patient.

The fact that an individual received therapy prior to admission to a hospital for a rehabilitation program does not necessarily mean that the initial assessment period was not reasonable and necessary. However, if during a previous hospital stay an individual completed such a program for essentially the same condition for which inpatient hospital care is now being provided, the assessment period could be covered only if:

Some intervening circumstance rendered such an assessment reasonable and necessary; or
The subsequent admission is to an institution utilizing techniques or technology not previously available or not available in the first institution.

110.3.2 - Specific Examples

After an inpatient hospital stay for rehabilitation care which resulted in little improvement in the patient's condition, an individual who undergoes surgery for severe contractures as a result of arthritis may require a reassessment of rehabilitation potential in light of the surgery.

The fact that an individual has some degree of mental impairment is not, per se, a basis for concluding that a multi-disciplinary team evaluation is not warranted. Many individuals who have had CVAs suffer both mental and physical impairments. The mental impairment often results in a limited attention span and reduced comprehension with a resultant problem in communication. With an intensive rehabilitation program, it is sometimes possible to correct or significantly alleviate both the mental and physical problems.

Absent other complicating medical problems, the type of rehabilitation program normally required by a patient with a fractured hip during or after the non-weight-bearing period or a patient with a healed ankle fracture does not require an inpatient hospital stay for rehabilitation care. Accordingly, an inpatient assessment is not warranted in such cases.[8] On the other hand, an individual who has had a CVA that left them significantly dependent in the activities of daily living (even after physical therapy in a different setting) might be a good candidate for a more extensive inpatient assessment if the patient has potential for rehabilitation and their needs are not primarily of a custodial nature.

110.4 - Rehabilitation Hospital Screening Criteria

Rehabilitative care in a hospital, rather than in a SNF or on an outpatient basis, is reasonable and necessary for a patient who requires a more coordinated, intensive program of multiple services than is generally found out of a hospital. A patient probably requires a hospital level of care if they have either one or more conditions requiring intensive and multi-disciplinary rehabilitation care, [9] or a medical complication in addition to their primary condition, so that the continuing availability of a physician is required to ensure safe and effective treatment. [10]

The QIOs will review rehabilitation services if they are rendered at the inpatient facility as part of that particular admission.

The CMS has developed a set of screening criteria to assist the QIOs in applying this level-of-care requirement. The criteria (which are listed below) are designed to enable the QIOs to identify those cases that clearly involve a hospital level of rehabilitative care. The QIOs are expected to use these criteria in performing their screens of rehabilitative hospital claims. Thus, if a case satisfies each of the criteria, the QIO may approve the claim at the initial screening level. However, the fact that a case fails to satisfy the criteria does not mean that the QIO denies the claim. Rather, it only means that the QIO refers the case to a physician reviewer for a determination as to the medical necessity of the patient's hospitalization. [11]

These criteria set forth below are intended to be applied only at the initial screening level (which is typically conducted by the QIO's nurse reviewer). The criteria do not apply to cases referred to a QIO's physician reviewer. For determinations about reasonableness, medical necessity, and appropriateness of setting, the QIO's physician reviewer is expected to make a determination on the basis of their knowledge, expertise and experience, and upon an assessment of each beneficiary's individual care needs rather than on fixed criteria.

At the initial screening, a QIO determines that the patient requires a rehabilitative hospital level of care if all of the following screening criteria are met. [12]

110.4.1 - Close Medical Supervision by a Physician With Specialized Training or Experience in Rehabilitation

A patient's condition must require the 24-hour availability of a physician with special training or experience in the field of rehabilitation. This need should be verifiable by entries in the patient's medical record that reflect frequent and direct, and medically necessary physician involvement in the patient's care; i.e., at least every two to three days during the patient's stay. This degree of physician involvement which is greater than is normally rendered to a patient in a SNF is an indicator of a patient's need for services generally available only in a hospital setting.[13]

110.4.2 - Twenty-Four Hour Rehabilitation Nursing

The patient requires the 24-hour availability of a registered nurse with specialized training or experience in rehabilitation.[13]

110.4.3 - Relatively Intense Level of Rehabilitation Services

The general threshold for establishing the need for inpatient hospital rehabilitation services is that the patient must require and receive at least three hours a day of physical and/or occupational therapy. (The furnishing of services no less than five days a week satisfies the requirement for "daily" services.) [14]While most patients requiring an inpatient stay for rehabilitation need and receive at least three hours a day of physical and/or occupational therapy, there can be exceptions because individual patient's needs vary. In some instances, patients who require inpatient hospital rehabilitation services may need, on a priority basis, other skilled rehabilitative modalities such as speech-language pathology services, or prosthetic-orthotic services and their stage of recovery makes the concurrent receipt of intensive physical therapy or occupational therapy services inappropriate. In such cases, the 3-hour a day requirement can be met by a combination of these other therapeutic services instead of or in addition to physical therapy and/or occupational therapy.

An inpatient stay for rehabilitation care can also be covered even though the patient has a secondary diagnosis or medical complication that prevents participation in a program consisting of three hours of therapy a day. Inpatient hospital care in these cases may be the only reasonable means by which even a low intensity rehabilitation program may be carried out. [15]The intermediary secures documentation of the existence and extent of complicating conditions affecting the carrying out of a rehabilitation program to ensure that inpatient hospital care for less than intensive rehabilitation care is actually needed.

110.4.4 - Multi-Disciplinary Team Approach to Delivery of Program

A multidisciplinary team usually includes a physician, rehabilitation nurse, social worker and/or psychologist, and those therapists involved in the patient's care. At a minimum, a team must include a physician, rehabilitation nurse, and one therapist.[16]

110.4.5 - Coordinated Program of Care

The patient's records must reflect evidence of a coordinated program, i.e., documentation that periodic team conferences were held with a regularity of at least every two weeks [17]to:

Assess the individual's progress or the problems impeding progress;
Consider possible resolutions to such problems; and
Reassess the validity of the rehabilitation goals initially established.
A team conference may be formal or informal; however, a review by the various team members of each other's notes does not constitute a team conference. The decisions made during such conferences, such as those concerning discharge planning and the need for any adjustment in goals or in the prescribed treatment program, must be recorded in the clinical record.

110.4.6 - Significant Practical Improvement

Hospitalization after the pre-admission screening is covered only in those cases where the pre-admission screening results in a conclusion by the rehabilitation team that a significant practical improvement can be expected in a reasonable period of time. [18]It is not necessary that there be an expectation of complete independence in the activities of daily living, but there must be a reasonable expectation of improvement that is of practical value to the patient, measured against the patient's condition at the start of the rehabilitation program. For example, a multiple sclerosis patient's condition may have deteriorated as a result of a secondary illness. To be restored to a level of function before the secondary illness, the patient may require an intensive inpatient hospital rehabilitation program. While such a program does not restore the level of function before multiple sclerosis developed, a return to pre-secondary illness level is considered to be a "significant practical improvement" in the condition. In addition, a beneficiary must classify into one of the CMG’s payable by Medicare under the IRF PPS.[19]

110.4.7 - Realistic Goals

While there may be instances where an intense rehabilitation program may enable a Medicare patient to return to the labor market, vocational rehabilitation is generally not considered a realistic goal for most aged or severely disabled individuals. The most realistic rehabilitation goal for most Medicare beneficiaries is self-care or independence in the activities of daily living; i.e., self-sufficiency in bathing, ambulation, eating, dressing, homemaking, etc., or sufficient improvement to allow a patient to live at home with family assistance rather than in an institution. [20]Thus, the aim of the treatment is achieving the maximum level of function possible.

110.5 - Length of Rehabilitation Program

Coverage stops when further progress toward the established rehabilitation goal is unlikely or when further progress can be achieved in a less intensive setting. [21]In deciding whether further care can be carried out in a less intensive setting, both the degree of improvement that has occurred and the type of program required to achieve further improvement must be considered. In some cases, an individual may be expected to continue to improve under an outpatient program. There are other situations where further improvement in the individual's ability to function relatively independently in the activities of daily living can be expected only if a multidisciplinary team effort is continued.

While occasional home visits and other trips into the community are factors in determining whether continued stay in the hospital is necessary, such excursions alone are not a basis for concluding that further hospital care is not required. Planned home visits and trips to the community are frequently used to test the individual's ability to function outside the institutional setting and assist in discharge planning for the individual.

It is also important to consider how close the patient may be to the planned end of the rehabilitation hospital stay when further progress becomes unlikely. If a patient is within a few days of discharge, transfer to a less intensive setting in another facility would be inappropriate even though further progress in the hospital setting is unlikely. However, it could be appropriate to utilize a "swing bed" arrangement, if it exists in the same facility, for rendering necessary services to the patient pending discharge.

When discharge or transfer to another facility is appropriate, the cut-off point for coverage should not be the last day on which improvement actually occurred. Rather, coverage should continue through the time it would have been reasonable for the physician, in consultation with the rehabilitation team, to have concluded that further improvement would not occur and to initiate the patient's discharge.

Since discharge planning is an integral part of any rehabilitation program and should begin upon the patient's admittance to the facility, an extended period of time for discharge action would not be reasonable after established goals have been reached, or a determination made that further progress is unlikely, or that care in a less intensive setting would be appropriate.[22]


IOM 100-04 Chpt. 3 Section 140 - Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

The statutory authority for the MR program includes the following sections of the Social Security Act (the Act):
Section 1833(e) which states, in part "...no payment shall be made to any provider... unless there has been furnished such information as may be necessary in order to determine the amounts due such provider ...;"
Section 1842(a)(2)(B) which requires contractors to "assist in the application of safeguards against unnecessary utilization of services furnished by providers ...; "
Section 1862(a)(1) which states no Medicare payment shall be made for expenses incurred for items or services that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member;"
The remainder of Section 1862(a) which describes all statutory exclusions from coverage;
Sections 1812, 1861, and 1832 which describe the Medicare benefit categories; and
Sections 1874, 1816, 1842 which provide further authority.


42 CFR 421.100 The regulatory authority for the MR program

IOM 100-08 Chpt. 1 Section 1.1.2 - Authority for the FI to review IRF claims

Social Security Act, Title XVIII, section 1888 [42 U.S.C. §1395ww(j)] defines the current IRF-PPS.

Social Security Act, Title XVIII, section 1154 (a)(2)(B) defines the utilization review requirement to review services that could be effectively provided more economically on an outpatient basis or in an inpatient health care facility of a different type.

Social Security Act, Title XVIII, section 1833(a)(8)(B)(i) allows payment for ancillary services and therapies when Part A coverage is not made.

Social Security Act, Title XVIII, sections 1861(v)(1)(G)(i) and (ii) allow payment at an average SNF rate when inpatient hospital care is not medically necessary but no post-hospital care beds are available.

Social Security Act, Title XVIII, section 1862(a)(1)(A) prohibits payments for services which are not medically reasonable and necessary.

Social Security Act, Title XVIII, section 1833 (e) prohibits payment if supporting documentation is not provided to Medicare.

42 Code of Federal Regulations (42 CFR): Sections 412.600, 412.23, 412.29, 412.25

Federal Register; Department of Health and Human Services; Centers for Medicare and Medicaid Services; Final Rules; Dates August 7, 2001; August 1, 2003; and May 7, 2004.

Program Manual A-01-110 contains instructions for the implementation of IRF-PPS.

Balanced Budget Act of 1997 (PL105-33, August 5, 1997), Subchapter B, Section 4421 establishes the PPS for IRF.

Omnibus Budget Reconciliation Act of 1987, (Pub 100-203) Section 4094.

Medicare Benefit Policy Manual (Pub 100-2), Chapter 1, Section 110.

Medicare Claims Processing Manual (Pub 100-4), Chapter 3, Section 140.
 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Mississippi
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 08/01/2007  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

 

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

This policy defines the limitations of Medicare coverage for Inpatient Rehabilitation services provided in free-standing and “excluded” rehabilitation units [SSA §1886 (d)(1)(b)]. The medical necessity for the provision of those services in an inpatient rehabilitation facility (IRF) is discussed. A distinction exists between medical necessity for individual therapy services, which may be reasonable and necessary in a particular case, and the medical necessity of providing those services in an inpatient rehabilitation environment (“medical appropriateness”). The Inpatient Rehabilitation policy addresses only the medical appropriateness of inpatient care following an admission (or transfer) to an IRF. It does not address inpatient rehabilitation provided as part of a medical-surgical stay in an acute care setting, nor does it address the medical necessity of specific therapeutic services when they are considered individually.

The coverage elements of the policy are organized into three sections:

 

  • The Policy in Briefsection provides an executive summary of the indications and limitations.
  • The General Indicationssection presents criteria for assessing the medical necessity of an inpatient rehabilitation stay as it applies to the individual patient. It also cross-references external regulatory requirements.
  • The Level of Evidence section applies the general criteria to specific clinical situations, focusing on the level of evidence required to support medical necessity and medical appropriateness in those situations./li>



The Utilization Guidelines section of the LCD discusses clinical categories with examples of the types of conditions and level of impairment that are envisioned as consistent with the category. In most cases the resultant disability is not discussed; the disability or collection of disabilities that necessitates inpatient rehabilitation is best considered at the level of the individual patient. The utilization guidelines are neither comprehensive nor absolute but are expected to serve as benchmarks. Most significantly, though, the Utilization Guidelines are expected to serve as benchmarks of the level of evidence that is expected to support the decision to admit. In no way should a patient be considered as ineligible for inpatient rehabilitation solely because of the diagnosis or degree of impairment. However, a patient with a medical diagnosis that is typically associated either with spontaneous improvement or a focal impairment (or, conversely, a lack of rehab potential) requires a very high level of evidence (documentation) in the medical record to conclusively demonstrate that an inpatient level of care is required and a less intensive SNF or outpatient setting would not adequately meet the rehabilitation needs.

The Policy in Brief


This policy defines the limitations of Medicare coverage for Inpatient Rehabilitation services provided in free-standing and “excluded” rehabilitation units. The policy addresses only the medical appropriateness of inpatient care following an admission (or transfer) to an IRF. It does not address the medical necessity of specific therapeutic services when they are considered individually.

Due to the unique considerations of each individual inpatient admission, Riverbend does not consider the automated review of cases to be reasonable. Medical necessity guidelines delineated in this policy must therefore always be applied to a specific case based on the documented unique circumstances of that case. However, in the absence of markedly extenuating circumstances, it can be expected that these medical necessity guidelines are applicable. This policy uses the concept of “Level of Evidence” to distinguish those types of cases that would typically be expected to be considered appropriate based on routine documentation from those cases in which the documentation would be expected to specifically demonstrate unusual circumstances or atypical conditions.
Inpatient Rehabilitation will be considered to be both medically necessary and medically appropriate if a patient meets BOTH of the following preconditions:

  • Precondition A: The patient MUST have a reasonable expectation of improvement. AND
  • Precondition B: The patient MUST have realistic goals for the inpatient stay.


AND the patient meets at least ONE of the following four conditions:

  • Condition 1: Medical Supervision. The therapy cannot be provided in a less intensive setting due to a need for frequent physician assessment or intervention in response to a significant risk of rapid change in physical or medical status OR
  • Condition 2: Rehabilitation Nursing.
    The therapy cannot be provided in a less intensive setting due to a need for 24-hour a day access to a registered nurse (RN) OR
  • Condition 3: Intense Rehabilitation Services. The patient requires either three hours per day of skilled therapy on a daily basis or, in the instance of a medical condition that limits participation, an equivalent amount of combined therapy and other nursing or orthotic interventions related to their need for rehabilitation, or requires specialized equipment that is not available on an outpatient basis OR
  • Condition 4: Multidisciplinary Team Approach. The patient requires the active and ongoing therapeutic intervention of at least two disciplines (physical therapy, nursing, occupational therapy, speech therapy, psychology/social work, and prosthetics/orthotics), one of which must be a therapy, and the disciplines must have a need for frequent interactions (tight coordination) in order to provide appropriate medical (rehabilitative) care.



The above indications for Inpatient Rehabilitation define medical necessity in all specific instances, but there are combinations of clinical situations (impairment, disability, disease and environment) that define cases that typically require an inpatient venue, that typically do not require an inpatient venue, and that typically MAY require an inpatient venue when certain conditions exist. The significance of the grouping is as follows:
1. Any case MAY be appropriate for inpatient rehabilitation.
2. A case of a type that is typically appropriate for inpatient should be presumed to require inpatient rehabilitation, assuming that other conditions such as capability of improvement are met, unless the medical record clearly and unambiguously shows that services can be provided on a less intensive basis.
3. A case of a type that can be typically performed in a less intensive setting should not be presumed to be appropriate for inpatient rehabilitation; rather, the medical record should clearly demonstrate that the less intensive setting of a SNF or the non-residential outpatient setting would not meet the clinical needs of this particular patient and would be less beneficial.
4. A case of the type that may have highly variable rehabilitation needs should not be presumed to require inpatient rehabilitation but should not require an unusual level of evidence to support a determination that a less intensive setting is inappropriate. However the documentation should still make a compelling case for the inpatient venue as opposed to a less intensive setting or a continuation of an acute inpatient stay.

The following categories of patients are presumptively considered appropriate for inpatient rehabilitation. Medical necessity should be apparent from the simple descriptive narrative in the medical record.
· Major Stroke
· Major Trauma
· Brain Injury
· Significant Spinal Cord Injury
· Major Burn

Many categories of patients are highly variable in their need for an inpatient venue. The documentation must make a reasonable case for the inpatient venue as opposed to a less intensive setting or a continuation of an acute inpatient stay. This is considered to be a moderate level of evidence. These cases include:
· Major Focal Trauma
· Peripheral Nerve Pathology
· Bilateral Knee Replacement
· Hip Fracture
· Amputation
· Auto-immune Disease with Focal Pathology
· All Others: Any category of patient not elsewhere described

Patients in the following categories may still require inpatient rehabilitation but this would be much less common. If inpatient rehabilitation is required, it is expected that the medical records of these patients must clearly, explicitly and unambiguously make a compelling case for the necessity of inpatient rehabilitation. This is a high level of evidence and indicates the situations in which additional effort and documentation may be required. These cases include:
· Auto-immune Disease with Diffuse Pathology
· Minor Trauma, including Compression Fractures
· TIA and Possible Neurologic Events
· Single Joint Replacement
· Post-operative and General Debility
· Coma Stimulation, Cognitive Rehabilitation
· Cardiac, Pulmonary and Pain Rehab

All patients are potential candidates for inpatient rehabilitation. It is the unique combination of impairments, disability, pathology and environment that establishes the medical necessity for an inpatient venue.





General Indications for Inpatient Rehabilitation

Regulatory Basis for Inpatient Rehabilitation

There is a regulatory limitation on coverage for inpatient rehabilitation that is based on the Social Security Act and published Medicare regulations. These regulations are not part of a Local Coverage Decision (LCD). Rather, they set limits on coverage that Local Coverage Decisions cannot exceed. These regulations are referenced in the CMS National Coverage Policy section (above) and discussed in the companion article (Related Documents section, below.)

Due to the unique considerations of each individual inpatient admission, Riverbend does not consider the automated review of cases to be reasonable. Medical necessity guidelines delineated in this policy must therefore always be applied to a specific case based on the documented unique circumstances of that case. However, in the absence of markedly extenuating circumstances, it can be expected that these medical necessity guidelines are applicable. This policy uses the concept of “Level of Evidence” to distinguish those types of cases that would typically be expected to be considered appropriate based on routine documentation from those cases in which the documentation would be expected to specifically demonstrate unusual circumstances or atypical conditions.

Medicare screening criteria do not create an absolute threshold between inpatient rehabilitation and a less intensive venue except in so far as a patient that simultaneously meets all criteria should be deemed appropriate for inpatient rehabilitation. Nonetheless those criteria individually create an established benchmark that has been in common usage for many years. Those criteria are:


1. Medical Supervision.
2. Rehabilitation Nursing.
3. Intense Rehabilitation Services.
4. Multidisciplinary Team Approach.
5. Probability of Practical Improvement.

Medical Necessity

Whereas screening criteria describe appropriateness based on meeting all five criteria combined with the establishment of reasonable goals, Medicare regulations do not prohibit coverage in other broader circumstances. Riverbend therefore defines the definitive medical necessity criteria for coverage of inpatient care as a medical rehabilitation requirement for any one of the key areas of intensive service:

Inpatient Rehabilitation will be considered to be both medically necessary and medically appropriate if a patient meets BOTH of the following preconditions:

    • Precondition A: The patient MUST have a reasonable expectation of improvement. AND
    • Precondition B: The patient MUST have realistic goals for the inpatient stay.


AND the patient meets at least ONE of the following four conditions:

    • Condition 1: Medical Supervision. The therapy cannot be provided in a less intensive setting due to a need for frequent physician assessment or intervention in response to a significant risk of rapid change in physical or medical status OR
    • Condition 2: Rehabilitation Nursing.
      The therapy cannot be provided in a less intensive setting due to a need for 24-hour a day access to a registered nurse (RN) OR
    • Condition 3: Intense Rehabilitation Services. The patient requires either three hours per day of skilled therapy on a daily basis or, in the instance of a medical condition that limits participation, an equivalent amount of combined therapy and other nursing or orthotic interventions related to their need for rehabilitation, or requires specialized equipment that is not available on an outpatient basis OR
    • Condition 4: Multidisciplinary Team Approach. The patient requires the active and ongoing therapeutic intervention of at least two disciplines (physical therapy, nursing, occupational therapy, speech therapy, psychology/social work, and prosthetics/orthotics), one of which must be a therapy, and the disciplines must have a need for frequent interactions (tight coordination) in order to provide appropriate medical (rehabilitative) care, OR




Special Assessment Condition: An Inpatient Rehabilitation stay will also be considered to be both medically necessary and medically appropriate for the purpose of performing an inpatient assessment if and only if an assessment in an outpatient, SNF, acute inpatient or other non-IRF environment could not be reasonably expected to provide sufficient information to make a determination regarding the patient's potential to benefit from an intensive coordinated inpatient rehabilitation program.


Specific criteria associated with the above conditions include:

Precondition A: The patient MUST have a reasonable expectation of improvement. Hospitalization after the initial assessment is covered only in those cases where a significant practical improvement can be expected in a reasonable period of time, i.e. a reasonable expectation of improvement that will be of practical value to the patient, measured against his condition at the start of the rehabilitation program. Vocational rehabilitation is generally not considered a realistic goal; the most realistic rehabilitation goal for most Medicare beneficiaries is self-care or sufficient improvement to allow a patient to live at home with assistance rather than in an institution. This practical improvement must also be expected to occur within a predictable and reasonable period of time. Both the anticipated extent of improvement and the expected time requirement should be defined at the time of admission although it is obvious that these projections may change as the clinical course evolves.

Precondition B: The patient MUST have realistic goals for the inpatient stay. The goals for the inpatient stay must be matched to the expectations of Precondition A. The goals must be measurable and must be tied to functional, physiological or medical outcomes that will be of practical value to the patient. They must also be realistic, associated with reasonable timeframes, and appropriate to the inpatient venue. Goals that significantly exceed typical goals for similar functional impairments (for example, a goal of ambulating ½ mile) are not considered realistic in the inpatient venue even though they may be perfectly appropriate long-term goals.

Condition 1: Medical Supervision.
If medical appropriateness is based on the medical supervision requirement, the patient must demonstrate a need for frequent physician assessment or intervention due to a significant risk of rapid change in physical or medical status. Note, however, that when a patient is transferred from an acute care facility, all acute medical conditions are covered under a Diagnostic Related Group reimbursement (DRG) and all care for the acute medical condition is reimbursed under that DRG. Although there is no single point at which "acute recovery" stops and "rehabilitation" begins, medical requirements of the acute recovery phase of an illness do not justify inpatient rehabilitation. Rather it is the rehabilitation needs, evaluated in light of the medical needs of co-morbid or complicating conditions, which constitute medical necessity for an inpatient rehabilitation stay. In other words, if the patient must be frequently assessed in order to manage treatment of the medical condition, this justifies an acute inpatient stay not an IRF stay. If the patient must be frequently assessed in order to tailor the rehabilitation protocol in response to rapidly changing medical or rehabilitation needs, this justifies an IRF stay. Frequent assessment or supervision is interpreted to mean a direct physician assessment and possible intervention every two to four days.

Condition 2: Rehabilitation Nursing.
The therapy cannot be provided in a less intensive setting due to a need for 24-hour a day access to a registered nurse (RN). To meet this condition, the medical record must demonstrate that:
1. the patient requires the care of an RN for the purpose of furthering the rehabilitative effort as opposed to meeting the medical needs of any underlying or comorbid medical conditions AND
2. the patient requires that care throughout the day and night AND
3. the required nursing services are not available in a SNF.
A requirement for an RN level of nursing care based on the underlying medical condition is appropriately an indication for acute hospital admission, a long term care facility stay, SNF placement or home nursing care. Patient and family education provided by registered nurses is a real requirement but does not necessitate 24 hour a day access to the RN.

Condition 3: Intense Rehabilitation Services.
If the medical appropriateness is based on a need for intense rehabilitative services, the patient must require:
a) three hours per day of skilled therapy on a daily basis OR
b) in the instance of a medical condition that limits participation, an equivalent amount of combined therapy and other nursing or orthotic interventions related to the need for rehabilitation, OR
c) a need for specialized equipment at such a frequency and duration as to make it impractical for the patient to use the equipment at an outpatient facility.
Treatments, therapies and equipment used to establish medical necessity under any of the clauses listed above must be consistent with the nature & severity of the illness or injury, and consistent with accepted standards of medical practice.

In determining the three hour total, the services must be those that can typically be provided only by a licensed physical therapist, occupational therapist, physical or occupational therapy assistant under the direct supervision of a licensed therapist, or speech-language pathologist. This LCD is not defining the practitioners; it is only defining the services that are considered to be significant in defining the intensity of service. Services that are typically provided by nurses, by respiratory therapists, by recreational therapists, by massage therapists, by therapy aides or by non-PMR physicians are examples of services that are not considered to contribute to the intense rehabilitative care, although they may be both medically appropriate and provided during the IRF stay. Although it would typically be much less than this, no more than one hour of modalities per day, interspersed with the active therapy, will be considered to contribute to the three hours of intense therapy, and then only if the administration of the modalities requires the skills of therapist.

It is not enough that intensive (three hours per day) therapy is provided; that level of intensity must also be required (medically necessary) AND it must be both reasonable and necessary to provide the care to a resident as opposed to a day patient. Three hours per day would not typically be considered to be medically necessary if:
1. Patients with similar impairments can be typically treated with less than three hours per day, or
2. Patients with similar pathology can be typically treated with less than three hours per day, or
3. Patients with similar impairments typically do not require therapy five days per week, or
4. Patients with similar pathology typically do not require therapy five days per week, and
Residential status would not typically be considered to be medically necessary if patients with similar disabilities can be typically treated in an outpatient (ambulatory or “day stay”) environment.

HOWEVER, IF the medical record supports a unique situation that would demand the higher level of intensity or frequency OR IF evidence-based medical literature supports better long term outcomes with the higher level of intensity or higher frequency, THEN intensive (three hour per day) therapy would be considered medically necessary regardless of prevailing or alternate practice patterns.

As a practical matter, it is unusual that a single discipline is needed at the level of three hours a day five days per week. (C.f. multidisciplinary care, below.) If the entire intensity condition (three hours daily) is met by a single discipline, it is expected that the medical record would clearly show that this level of intervention was medically necessary and inappropriate for a SNF or outpatient venue.

In determining an equivalent intensity in the absence of three hours of formal therapy, consideration will be given to supportive and restorative care only when that care is essential to get the patient to the point at which intensive (three hour daily) is tolerated AND the preparatory care cannot be provided in a less intensive environment. It is expected that this requirement will be clearly supported by the medical record.

In determining the need for specialized equipment in the absence of three hours of formal therapy, it is expected that the patient requires the equipment in order to progress to the point that intensive (three hour daily) will be tolerated and that this requirement is clearly supported by the medical record.

Condition 4: Multidisciplinary Team Approach.
A multidisciplinary team must include, at a minimum, a physician, rehabilitation nurse and one therapist. The patient's records must reflect evidence of a coordinated program that includes joint involvement in evaluation and decision-making and must also show the medical necessity of that coordination.

1. The patient must require the active and ongoing therapeutic intervention of at least two disciplines (physical therapy, nursing, occupational therapy, speech therapy, psychology/social work, and prosthetics/orthotics), one of which must be a therapy, AND

2. the coordination between the disciplines must be sufficiently tight to require frequent formal (biweekly) meetings and informal (ongoing or every few days) communications in order to coordinate therapeutic interventions, AND

3. it must be apparent from the medical record that the tight coordination was needed to benefit the patient, i.e. to frequently adjust the plan of care of one discipline in response to the assessment or treatment of the second discipline, or to create a joint plan that coordinates the interventions in order to optimize benefit or minimize stress to the patient.

As a practical matter, it is unusual that tightly coordinated multidisciplinary care is needed at the level of less than three hours a day five days per week. (C.f., intensive rehabilitation above.) If the multidisciplinary condition is met through the provision of less than three hours daily, it is expected that the medical record would clearly show that this level of coordination was medically necessary and unattainable or inappropriate in a SNF or outpatient venue.

In considering the requirement for coordinated multidisciplinary therapy, two disciplines (such as physical therapy (PT) and occupational therapy (OT) or PT and nursing) are required only if each discipline brings a unique skillset to the treatment regimen. Treatment that, in other circumstances, is typically or frequently provided by a single discipline is not considered multidisciplinary.


Special Assessment Condition: An Inpatient Rehabilitation stay will also be considered to be both medically necessary and medically appropriate for the purpose of performing an inpatient assessment if and only if an assessment in an outpatient, SNF, acute inpatient or other non-IRF environment could not be reasonably expected to provide sufficient information to make a determination regarding the patient's potential to benefit from an intensive coordinated inpatient rehabilitation program.
1. An assessment to determine a requirement for inpatient level of care does not require an inpatient setting. These assessments can be conducted at the sending facility or in an outpatient setting.
2. An assessment to determine the capability of the patient for tolerating intensive rehabilitation MAY occasionally require an intensive evaluation during a trial of therapy in an inpatient environment. In this instance the medical record should clearly document the reason for the inpatient assessment and support its necessity. A pre-admission assessment is almost always considered reasonable and necessary unless it repeats a recent evaluation or a conclusion of inappropriateness should have been apparent on the basis of referral information. However an inpatient assessment for possible inpatient rehabilitation will be considered to be not medically necessary if the condition precipitating the assessment typically does not require inpatient rehabilitation and the medical record does not clearly identify a compelling reason to believe otherwise.


Requirement for SNF Level of Care: A determination that the patient is not yet at a level of self-care to live alone is NOT a factor in the determination of a need for an IRF level of care. Patients who require an inpatient rehabilitation stay based on an intensity or multidisciplinary requirement may need that stay in order to improve their ability to function independently, but this determines the need for rehabilitation therapy not the need for the inpatient venue. Conversely, a determination that a patient is not yet at a level of self-care to live alone IS a factor in the determination of a need for SNF placement, as long as there is also a requirement for skilled services on either a medical or rehabilitative basis. In other words, a patient who needs intensive inpatient multidisciplinary care is appropriate for an IRF regardless of whether or not he is functionally capable of going home. A patient who is not capable of going home but does not require intensive multidisciplinary care is appropriate for a SNF and can receive skilled services there.


III. Application of General Principles to Specific Diseases: Level of Evidence.

There is a limited collection of peer-reviewed literature comparing the relative effectiveness of inpatient rehabilitation with intensive outpatient rehabilitation or SNF rehabilitation in the high level resource utilization groups. However it is clearly Congress’ statutory and CMS’ regulatory intent to permit those patients requiring intensive rehabilitation to receive it in an inpatient venue but to also direct all patients to the least intensive and most cost effective level that will meet their medical needs. In those few instances where controlled trials exist, that level of evidence is considered definitive. In the remainder of clinical scenarios, Riverbend reiterates that it is the unique combination of circumstances that determines medical appropriateness in a given situation; patients should not be included or excluded solely on the basis of diagnosis, impairment, disability, age, comorbidity, living environment or any other screening criterion.

The need for inpatient rehabilitation should be determined first and foremost by the impairment and disability, or limitation of activity or participation. The International Classification of Functioning, Disability and Health or other comparable taxonomy may be valuable in categorizing or reporting the target of the therapeutic intervention. However, since all IRF medical appropriateness determinations will be based on the entire medical record rather than an encoded abstract, the complete documentation of the impairment and disability in the assessment is much more important than the category into which the impairment falls. This is the primary reason why specific ICF codes are not listed for either approval or disapproval.

The need for an IRF stay is determined secondly by the probability of improvement with treatment. This is in turn determined both by the specific impairment and by the pathology (disease) that underlies it. However, rehabilitation needs overall must also be considered in light of the probability of similar recovery with less intensive or self-directed care; medical necessity only exists when the intensive intervention is clearly or probably superior to the less intensive option. The probability of recovery (prognosis) is also driven primarily by the underlying pathology. Once again, though, since all IRF medical appropriateness determinations will be based on the entire medical record rather than an encoded abstract, the complete documentation of the pathology in the assessment is much more important than the disease category into which the pathology falls. This is the primary reason why specific ICD9 codes are not listed for either approval or disapproval.

The General Indications for Inpatient Rehabilitation define medical necessity in all specific instances, but there are combinations of clinical situations (impairment, disability, disease and environment) that define cases that typically require an inpatient venue, that typically do not require an inpatient venue, and that typically MAY require an inpatient venue when certain conditions exist. The significance of the grouping is as follows:
5. Any case MAY be appropriate for inpatient rehabilitation.
6. A case of a type that is typically appropriate for inpatient should be presumed to require inpatient rehabilitation, assuming that other conditions such as capability of improvement are met, unless the medical record clearly and unambiguously shows that services can be provided on a less intensive basis.
7. A case of a type that can be typically performed in a less intensive setting should not be presumed to be appropriate for inpatient rehabilitation; rather, the medical record should clearly demonstrate that the less intensive setting of a SNF or the non-residential outpatient setting would not meet the clinical needs of this particular patient and would be less beneficial.
8. A case of the type that may have highly variable rehabilitation needs should not be presumed to require inpatient rehabilitation but should not require an unusual level of evidence to support a determination that a less intensive setting is inappropriate. However the documentation should still make a compelling case for the inpatient venue as opposed to a less intensive setting or a continuation of an acute inpatient stay.

These situations could be grouped either by impairment, by disability, by pathology or by some other combination of common characteristics. PM&R physicians are typically fully conversant with IRF standards, though; it is referring physicians who benefit most from a screening taxonomy that provides insight into why an IRF might redirect a particular patient to a less intensive setting. Since non-physiatrists are most conversant with a classification based on pathology, this grouping is retained. In order to emphasize that the underlying pathology is useful in establishing general expectations but cannot be used to allow blanket approvals or denials, the discussion of the level of evidence expected to support a given category of patients is considered to be a Utilization Guideline and can be found in that section. It is emphasized that any patient, regardless of the etiology of the impairment and disability, may be appropriate for inpatient rehabilitation if the inpatient conditions are met, the disability is not expected to resolve with the resolution of the underlying pathology, and the documentation clearly supports the requirement for the inpatient care.

From a policy standpoint, certain categories of patients are presumptively considered appropriate for inpatient rehabilitation. Medical necessity should be apparent from the simple descriptive narrative in the medical record. A low level of supporting evidence is therefore required to support medical necessity. These cases include:
· Major Stroke
· Major Trauma
· Brain Injury
· Significant Spinal Cord Injury
· Major Burn

Many categories of patients are highly variable in their need for an inpatient venue. Medical necessity may not be apparent from the simple descriptive narrative in the medical record. Admitting physicians should pay careful attention to cases in these categories and utilization review committees should consider them to be their bread and butter. Many of these cases will be appropriate for inpatient rehabilitation but many will also be appropriate for, at one end, a less intensive setting or, at the other extreme, a delay in admission until the episode of acute inpatient care has been completely addressed. The documentation must make a reasonable but explicit case for the inpatient venue as opposed to a less intensive setting or a continuation of an acute inpatient stay. This is considered to be a moderate level of evidence. These cases include:
· Major Focal Trauma
· Peripheral Nerve Pathology
· Bilateral Knee Replacement
· Hip Fracture
· Amputation
· Auto-immune Disease with Focal Pathology

Some categories of patients are typically but not always treated in less intensive settings. Patients in these categories may still require inpatient rehabilitation but this would be much less common. If inpatient rehabilitation is required, it is expected that the medical records of these patients must clearly, explicitly and unambiguously make a compelling case for the necessity of inpatient rehabilitation. In other words, both the physician and the facility are expected to explicitly evaluate the need for inpatient care since other options are frequently available. If those other options are considered and rejected as inappropriate, the medical record must clearly document that they were considered and the rationale for the rejection. Implicit evidence is acceptable in other categories; in these groupings an explicit rationale is required and must be supported by the facts of the case. This is a high level of evidence and indicates the situations in which additional effort and documentation may be required. These cases include:
· Auto-immune Disease with Diffuse Pathology
· Minor Trauma, including Compression Fractures
· TIA and Possible Neurologic Events
· Single Joint Replacement
· Post-operative and General Debility
· Coma Stimulation, Cognitive Rehabilitation
· Cardiac, Pulmonary and Pain Rehab

A complete discussion of Levels of Evidence is included in the Utilization Guidelines section of this policy.


 

 

Coverage Topic 

Hospital Care (Inpatient)
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

99999

Not Applicable

 

 

CPT/HCPCS Codes 

 

XX000

Not Applicable

 

 

ICD-9 Codes that Support Medical Necessity 

 

XX000

Not Applicable

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

The primary goal of documentation is to convey historical medical information to future caregivers. Documentation as legal evidence of the conditions under which a service is provided is a necessary but clearly secondary goal. Documentation should not be created solely to meet a regulatory requirement, nor sh