The documentation of impairments, activity limitations and disability is a complex task. The resultant clinical record must support both the implementation of a beneficiary-specific care plan and Medicare reimbursement. If your organization has no difficulty capturing relevant health information for its patient population, please skip this article. Not sure? Please take this opportunity to learn about the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF) - it could be what your organization needs.
The ICF is a taxonomy (a classification system) developed and tested over the past two decades. The ICF provides a comprehensive, valid and reliable way of classifying 'functioning and disability' and 'contextual and personal factors' relevant to therapeutic care plans throughout the continuum of care. The incorporation of ICF domains and categories into clinical documentation would thus increase the specificity and quality of your organization's clinical records.
Palmetto GBA has incorporated the ICF into its educational materials for a variety of Part A provider services - ranging from hospital to home health. The ICF facilitates provider education because it provides a common language for communicating Medicare coverage and documentation requirements to all Part A providers - some of whom are vertically integrated. This same characteristic makes it ideal for use by Part A providers in their clinical documentation and care planning.
As described in the WHO's introduction to the ICF, the ICF has two parts, each with two
components:
- Part 1 - Functioning and Disability
- Body Functions and Structures
- Activities and Participation
- Part 2 - Contextual Factors
- Environmental Factors
- Personal Factors
The first three components are further described using domains, and within domains categories. The ICF allows enhancement of the information contained in the International Classification of Diseases (ICD) by allowing users to go beyond diagnosis when describing an individual or population. The additional information helps highlight care opportunities that may otherwise be missed.
For more information on the background of the ICF and to view the ICF on- line you may visit the WHO Web site at www.who.int/classifications/icf/en/.
For an example of how Palmetto GBA has incorporated the ICF into its educational materials, please see Palmetto GBA's Local Coverage Determination (LCD) addressing teaching and training services for Medicare home health beneficiaries with Alzheimer's disease and behavioral disturbances. To view this LCD from the Palmetto GBA Web site:
- Go to www.PalmettoGBA.com/rhhi/lcd
- Click on LCDs and NCDs
- Select Active under Local Coverage Determinations (LCD) - RHHI
- Scroll down and select LCD ID Number L19817 (Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances). This will take you to the Medicare Coverage Database Disclaimer page.
- Scroll down and select Accept
Under the 'related documents' section of the LCD there are two ICF-based case scenarios, each containing potential interventions based on the ICF descriptions.