Document Type
Presentation
Publication Date
2026
Faculty Mentor
Corey Morrow
Abstract
Purpose: Post stroke depression (PSD) is the most frequent and burdensome mental health complication following a stroke, affecting approximately one third of survivors. Examining how PSD relates to outpatient occupational therapy (OT) utilization may help identify gaps in post-stroke mental health care and reveal whether current billing practices adequately capture OT services.
Project Goals: This project aimed to determine whether an early PSD diagnosis predicts outpatient OT treatment intensity and describe patterns of OT billing related to mental health, including mental health current procedural terminology (CPT) code use and CPT code distributions.
Site: This project was conducted in collaboration with a research lab that specializes in analyzing large health care datasets to inform rehabilitation policy and practice.
Design and Methods: A retrospective cohort analysis of hospitalized stroke survivors was conducted using the 2017-2022 national Medicare outpatient claims. The exposure variable, early PSD, was defined as a new depression diagnosis during the index hospitalization or within 30 days of discharge. The primary outcome was outpatient OT treatment intensity, measured as total OT units delivered 31–364 days post‑discharge. Secondary outcomes included mental health CPT treatment code use, CPT treatment code distributions for OT visits, and PSD timing relative to OT initiation.
Results: Among 23,604 stroke survivors, early PSD diagnosis was independently associated with greater outpatient OT intensity, corresponding to a 35% increase in expected OT units (IRR 1.35, 95% CI 1.10–1.69, p = .006). There were 0 claims billed by OTs involving mental health CPT codes across the cohort, and unadjusted CPT code distributions were nearly identical between groups, indicating no transparent differences in treatment approaches for stroke survivors with PSD
Conclusion: Despite higher OT intensity among survivors with PSD, mental‑health focused OT work remains largely invisible in claims data, underscoring the need for billing and coding practices that more accurately reflect OT’s role in supporting mental health after stroke.
Recommended Citation
Allen, Lauren H., "Post-Stroke Depression (PSD) and Occupational Therapy (OT) Intensity: A Retrospective Medicare Claims Analysis" (2026). Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium. 112.
https://medica-musc.researchcommons.org/muscotd-elotd/112