How to Document Co-Treatments in IEP’s

GUEST BLOGGER: Kathryn Biel.

Marcia submitted this clinical question:

We’ve had some discussion around co-treatments and how best to document them in IEP’s — I’d love to get some input as to what is happening in other districts — is it being specifically documented on the service delivery page, additional information, and if so how?? (ie: for a 1 hour co-treat small group with PT & SLP — how is that documented in the IEP?? Is it in the grids as 30 minutes for each?? 1 hour for each??). Thanks in advance — I look forward to getting feedback from this group! 

This one I think will vary, depending on state regulations and reimbursement issues. I’m in New York, so I can only speak to what we’re doing in my region. This is also my understanding, so please feel free to jump in and tell me if I’ve got it wrong. I’ve never been allowed to put a co-treat on an IEP, mostly due to Medicaid reasons. Medicaid does not allow co-treats. According to most districts I’ve been in, if the service is on the IEP, it should be reimbursable. I’ve worked in districts with a very high Medicaid-eligible percentage, so every IEP was treated as if it were being submitted to Medicaid (also because you can retroactively claim Medicaid as well).

So, let’s try this example: A PT/SLP co-treat that is 1 hour long, which takes place one time per week. PT sees the student one more time individually and speech has two more individual sessions. On the co-treat day, PT and SLP would each bill for 30 minute individual sessions but at different times (10-10:30 for PT, 10:30-11 for SLP). The Related Services would be listed at PT two times per week, individual, 30 minute sessions, and SLP would be listed as three times per week, individual, 30 minute sessions.

Personally, I would then add in a PT and an SLP consult under Support for School Personnel and describe the consult to include the co-treat. This way, you have the accountability in the IEP to carve out the time in your schedules to include the co-treat. I would also state the need for/purpose of the co-treat somewhere in the Physical Development Section of the IEP.

Co-treats are a vastly underutilized service, in my book. Sometimes, to get around this, the OT and PT staff (because we share treatment space) will plan one activity that we do together with our students. This doesn’t help with the PT/SLP or SLP/OT co-treat. Obviously, scheduling becomes another issue as well.

I would love to hear how other therapists would or do document co-treats. Please let me know, and Margie, I hope this helps! 

~Kathryn Biel, PT, DPT