Phone: 866-782-6258

Documenting Skill with Modalities

Todd Olson, OTR/L

April 23, 2019



How do you document "skill" appropriately when performing modalities?  


Many Medicare administrative contractors state that modalities are an adjunct to treatment and they do not expect to see more than two to three treatments before something active should be added to the treatment program. There's language in the RAI manual regarding modalities. In my organization, we've had to refer to this often when talking about documenting for modalities. This statement from the RAI manual states that only the time that is skilled may be recorded on the MDS. For example, a resident receiving TENS for pain management, the portion of treatment that is skilled, would be proper electrode placement, establishing proper pulse frequency and duration, and determining the appropriate stimulation mode, shall be recorded on the MDS. The use and rationale for all therapy modalities, whether skilled or unskilled, should always be documented as part of the resident's plan of care. My organization's Medicare administrative contractor is Noridian (these do vary depending on where you are located in the US). The portion of time that can be can be recorded and what they list as billable time with modalities are: proper electrode placement, establishing proper settings, removal of electrodes, and examining the skin before and after treatment. There is not a lot of "skilled" time for physical agent modalities. Documentation is key to supporting all skilled interventions no matter the procedure, including modalities. We need to note that the presence of a modality on a plan of care or in a daily note does not necessarily make it skilled, just because it's there. All regulatory language concerning skilled therapy delivery and documentation also applies to physical agent modalities.

Key components of documenting skill are:

  • modality must be clarified as part of the treatment plan including the location, frequency, and anticipated duration
  • the reason for the modality must be clearly described
  • the modality must be supported by the documentation in the rest of the chart
  • documentation should highlight the complexity and the necessity of using the modality,
  • relate the modality to an objective scale such as pain scale or edema,
  • document any adjustments and modifications.


todd olson

Todd Olson, OTR/L

Todd Olson, in his 22+ years of rehabilitation practice, has worked in acute care, inpatient rehabilitation, outpatient, and long-term care as a clinician, operator, researcher, legal expert witness, consultant, and educator.  In his current position as the Director of Clinical Education and Training for Brighton Rehabilitation, he provides continuing education, clinical, operational, and regulatory support to over 600 therapists throughout the western United States.  In this position, Todd has presented licensure approved clinical education programming on dementia management, falls and balance, pain management, activities of daily living, function-based intervention, documentation and coding, and regulatory/reimbursement compliance.  Todd also serves as Brighton’s electronic medical record (EMR) Clinical Applications Director. In this role, he provides EMR clinical, operational, financial, regulatory, and IT support to Brighton’s employees and customers. In addition, Todd is the Owner and President of Athena Therapy Consulting which provides quality assurance, auditing, and operational support to clinical and legal clients.  Outside of work, Todd enjoys spending time with his family and tempting fate on his snowboard and mountain bike in the Wasatch Mountains surrounding his home of Park City, Utah. 


Related Courses

Pain Management in Long Term Care
Presented by Todd Olson, OTR/L
Recorded Webinar


Todd Olson, OTR/L
Course: #3376Level: Introductory2 Hours
  'very good review of modalities which we tend to gloss over, would have liked more examples of goals and use of objective measures for using pain scales'   Read Reviews
This course focuses on pain management programming in the long-term care setting from a therapist perspective as well as the interdisciplinary team approach. Participants will be able to define the classifications of pain, discuss how and why to implement pain management programming, understand the assessment process, identify skilled treatment options including a review of physical agents, and understand the components skilled documentation. This course is directly related to the practice physical therapy and is therefore appropriate for the PT and PTA.

Put Down the Drugs: Evidence-Based Interventions to Reduce Unwanted Behaviors with Dementia
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar


Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3072Level: Intermediate1 Hour
  'Thank you for your differentiation between early, mid- and late-stage dementia and how to change the approach to be more successful with a resident in each of those stages!'   Read Reviews
PTs can apply evidence-based interventions to improve dementia care. This session reviews the etiology of common behaviors. Cognitive-emotion, multi-sensory, animal-assisted, and exercise interventions to reduce agitation are discussed as well as specific strategies for improving task-related engagement. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Clinical Use of the Reformer for the Lower Body
Presented by Rhondi Miller, PT, MS, SCS, ATC
Recorded Webinar


Rhondi Miller, PT, MS, SCS, ATC
Course: #3329Level: Intermediate2 Hours
  'Therapeutic focusVideo instructionKnowledge of instructorExplanations and using guides'   Read Reviews
The reformer is an effective tool for rehabilitating the lower body. This course will provide exercises appropriate for progressing lower extremity rehab from ankle injury, to post-op knees, to hip pain. Exercises focus on the concepts of motor control, stability/mobility system balance, movement competency and training functional movement patterning. This course is part three of our four part series on Pilates. This course is directly related to the practice of physical therapy and athletic training and therefore appropriate for the PT/PTA and AT.

Wheelchair Seating: Considerations for the Hands-Free Sitter
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar


Michelle Lange, OTR, ABDA, ATP/SMS
Course: #3585Level: Advanced1 Hour
  'Concise, to the point information'   Read Reviews
Wheelchair seating is designed to provide postural support and alignment, stability for function and mitigate pressure issues. This course will address assessment and intervention when working with a client who can sit without the support of their hands, referred to as the ‘hands-free’ sitter.

Switch Assessment
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar


Michelle Lange, OTR, ABDA, ATP/SMS
Course: #2818Level: Advanced2 Hours
  'Information was straightforward and easy to understand'   Read Reviews
Assistive technology provides independence in the areas of mobility, communication, education, vocation, and activities of daily living. To benefit from this technology, the client must be able to access it. This course addresses one access method, switches, and how to determine the best switch location and type to match a client’s needs.