On “Medicare mandate for claims-based functional data collection…” [editorial]. Resnik L. Phys Ther. 2013;93:587–588.

In her editorial for the May issue of PTJ,¹ Resnik discussed a topic that has seemed to have eluded our practice to varying extents but has serious implications to how we practice as physical therapists—that is, operationalizing functional reporting using the International Classification of Functioning, Disability and Health (ICF).² The World Health Assembly approved the ICF in 2001 as the universal model and classification system to describe the functioning of individuals with various health conditions; the ICF is universal in that it can be used across health care, geographic, and cultural settings. Twelve years later, with the Medicare requirement, the field of physical therapy in the United States is witnessing a positive change in terms of systematically implementing the ICF in clinical practice. For better or worse, it took a governmental mandate to formally initiate the change; nevertheless, it is a step in the right direction and for a good reason, and, truly, it is about time.

In July 2010, PTJ devoted a special section titled “Focus on the ICF.” The section consisted of 2 articles that critically disentangled the issue of how the ICF could be utilized in clinical physical therapist practice and its benefits in guiding patient management.^3,4 In that special section, the authors proposed concrete ways in which the ICF can be implemented in clinical practice,³ and aspects of those proposals could be made consistent with Medicare's recent requirement of functional reporting.⁵ The first proposal was to use a list of ICF categories from the Generic Set⁶ and, for each category, document the impairment, limitation, or restriction using a global numerical or percentage rating. The second proposal was to use a template where each ICF category from a list relevant to a specific health condition or setting (ie, ICF Core Set) is to be examined, including the test or measure used to assess that category, the test's or measure's value or result, its relation to goals, the prognosis, and the type and frequency of intervention. The template also included reexamination, where the same tests or measures are readministered and therapy goals are revisited. This second proposal delineated the process of patient management from initial examination to evaluation, prognosis and plan of care, intervention, and reexamination.³ In the same special section of PTJ, these proposals were implemented in a case of a patient with spinal cord injury,⁴ making the illustration concrete.

Relating the ICF back to the Medicare requirement for the reporting of functional limitation, these 2 proposals can be blended (eg, by assigning and assessing the G code using information gathered from specific ICF categories). For example, for the Medicare G code relating to “Carrying, moving, and handling objects,”⁵ the ICF categories d430 (Lifting and carrying objects), d435 (Moving objects with lower extremities), d440 (Fine hand use), and d445 (Hand and arm use) could be assessed to provide the physical therapist with a comprehensive picture of the patient's functioning relevant to that particular G code. Thus, in this case, the ICF does provide concrete concepts of functioning that are more specific than the Medicare-prescribed G code. To increase the added value of the ICF, physical therapists need to indicate and reflect the G code (and the ICF category or categories that capture that G code) when doing their assessments, developing therapy goals, and planning interventions.

There are challenges in assessing and reporting G codes, some of which are related to the whole discussion of ICF utility in practice,⁷ including issues regarding administrative burden, assessment reliability, and converting a score from a specific measure to a common global severity qualifier. However, it is a worthy start toward utilizing a standard classification system and language to deliver the best patient care possible and with the most efficient intervention possible.

The ICF, however, needs to be complemented by other “tools”; hence, the articles in the special section did not solely use the standpoint of the ICF but also gave equal consideration to using the American Physical Therapy Association's Guide to Physical Therapist Practice (the Guide),⁸ which is currently undergoing revision. The ICF, along with the Guide, can and should be used by physical therapists in their daily clinical thinking, practice, and documentation when assessing functioning domains of patients across a continuum of care. When used together, the ICF and the Guide become a powerful tool in implementing the Medicare mandate. The joint use of the ICF and the Guide is beneficial because it will provide physical therapists with the resources to efficiently identify areas of functioning that need to be addressed and to prudently assess those areas using current evidence and robust measures—all of which can advance the field of physical therapy and ultimately benefit patient care.

• © 2013 American Physical Therapy Association