97530 CPT Code: Know Your Codes
97530 CPT Code Description: Direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. When using 97530, you should focus on tasks ending in ‘ing’ such as carrying, lifting, handling, reaching, transferring, and transporting to improve overall function. Specific examples include hand assembly activities, transfers (chair to bed, lying to sitting, etc.), swinging, catching, lunging, and throwing. The best practice is to determine what functional outcome is expected from the task. Your documentation needs to include the specific focus of the functional task and/or activity and should be clearly identified in the goals for 97530.
CPT 97110 Vs. 97530
- CPT code 97110 is a therapeutic procedure, on one or more areas, each lasting 15 minutes. Therapeutic exercises are performed in either an active, active-assisted, or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening) approach. The exercises may be reasonable and medically necessary for a loss or restriction of joint motion, strength, functional capacity, or mobility that has resulted from a specific disease or injury.
- The primary differentiation between the two codes is the number of target areas being addressed during the activity. In order to determine the more appropriate code, the therapist must use their clinical expertise and task analysis of the activity to determine what skills are being addressed during the treatment session.
- Is the patient sitting in the wheelchair and using 2# ankle weights? This is best billed under 97110. Is the patient using 1# cuff weights while participating in a fine motor task at the tabletop? This activity is best billed under 97530 CPT code. Is the patient standing on a balance board while reaching for items at multiple levels? This activity is best billed under 97530. Is the patient using a stationary bike with increased resistance for lower extremity strengthening? This is best billed under 97110.
Your documentation should include the areas you targeted for improvement and a detailed description of those activities. Explain why you chose these activities to remediate the deficit areas. Make a clear connection between the activity and its role in restoring a function of daily life. Include the level of assistance you needed to provide the patient during the activity.
For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for its accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com
CPT codes and their descriptions and the policies discussed in this article do not reflect or guarantee coverage or payment. Just because a CPT code exists, payment for the service it describes is not guaranteed. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country.