Mary Kostka walks through the pediatric discharge process: start the conversation when kids hit about 80% of their therapy goals, allow at least three visits from that initial talk, and complete the green checklist and sensory measure in-clinic. Bill the sensory test before the final day, never on the same day as the discharge evaluation code.
Questions this video answers
About 80% of goals met.
At least three visits.
No — they cannot be billed on the same day; testing must be billed prior to the last day.
At least one week before the scheduled graduation date.
Hey, guys, I'm making a little instructional video on when to discharge kids and how to do it. So in the filing cabinet, we have these green forms, discharge checklist, and we have the testimonial sheet attached to it. So when you're starting to think that somebody might be ready for discharge and you want to start thinking about this, when they've met about 80% of their goals, they're progressing on the last two. That's when we usually are starting to think about graduating. And I have told them that in the beginning that we typically graduate at about 80% of goals met. So you'll just put their name and the date that you start this discussion. So the first thing is just started the discussion. So, you know, sometimes parents react differently than you think they're going to. And so you say, you know, when Mary evaluated, she said we typically graduate at 80% of goals met. Your child's now at whatever they are at 80%, 85%, 100%, whatever you want to tell whatever it is. And then you say, you know, how are you feeling? What do you think? Now? Sometimes the parents are just like, oh, yeah, I think they're totally ready. And then it's easy to move forward. Other ones get the little deer in the headlights, and they're kind of panicked because they don't, you know, want to stop. And then you get a sense of how they're feeling. And then you can. You also want to talk about this. If we're kind of getting close to the visits, the plan of care, and you want to allow at least three visits from this discussion to wrap it up. So you want to start this discussion. You know, if we have 36 visits and we're at 30, should already be talking about it. Okay, so you check off if you talked about it, you might make some notes on what they said or how they're feeling. And if they're a little hesitant and you're able to add visits, you can do a Prague. You could add some visits and you might decide, yeah, you know, we're not quite ready in like three or four visits. But, you know, how about if we'll add eight or just whatever you decide on, you can leave a little bit of a cushion there, especially if they're molina. You have to consider the insurance. So once you set the date, you put the date there. And then you're also going to be sure to write it on the little by the door. You know, we have a place for discharges. And then also let Emily know because they are doing the Schedule weeks ahead of time. So they need to know when that spot's going to open up and then when it's ready. You want to make sure that you let me know or let Kylan know. Right now, it's me. The next step is that you want to take the sensory processing measure out from the file and you want to have them put X's instead of O's for the current and put X equals whatever the date is that they fill it out and have them fill out both sides. And then you can have one that aids Emily. You can have Emily or Kylie score it, or just whoever's trained in scoring it can score it. You want to make sure that you bill for that testing before the last day, because we cannot do this code and the. The discharge eval code on the same day. So you want to make sure you get this. It can be prior to. Anytime prior to the last day. So basically do it. The day you have them fill that out, then you're going to look in the eval and find out what the original concern level was. So say it was an 8. Usually it's 7, 8, 9. And then you're going to ask them, you know, when you came, your concern level was like an 8 out of 10. What would you say it is now? And typically it's never zero. It's usually like one, two or three. And so you put their current rating there, because I'm going to put that in the report. Retesting clinical observations. Typically we don't even have to do this because that would be all the things in the grid, like the reflexes and the core strength. And if they've met that goal and they've already done all of those things, we don't usually have to do any retesting of that. If there have been other tests, you would want to alert myself or Kylan will need to redo some tests. If other tests were done, then. So one day to start talking about it, setting the date, another day to have them fill out the sensory processing measure. And you can usually ask them that the same day. If we need another to do any testing, extra testing, we need a day to do that. The testimonial is on another day we have them do that in clinic because they never fill it out when they take it home. So after they have this all fresh in their mind, then you have them fill out this one and you just give them a clipboard and have them fill it out while they're at the clinic, and then that's it. So when those things are done, then I'm able to write it up. And I need to be able to write it up a good week, at least a week before their graduation. You want to make sure all that's done so that I can write it up, because I like them to read it on that last day. And then the rest of these things are just making sure that we have the gift card, the certificate. We. We want to take a picture. You want to make sure you charge this code on the last day. And then this is just stuff that we check off to make sure got done that it went to the doctor. I check and make sure we have an OT signature on every page and that there isn't any information missing. And then they get moved in our email list, in our Excel sheet, et cetera. So. So that is our plan. So you need at least three visits to get all this done. So you want to start. We don't want this to kind of happen suddenly. It's very stressful. If we kind of have to be like, oh, we're discharging them next week. That is not enough time, and that is it.
