97535 CPT Code: Know Your Codes
97535 CPT Code: Self-Care/Home Management Training
97535 CPT Code Description: Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes.
- This procedure is medically necessary only when it requires the professional skills of a provider, is designed to address specific needs of the patient, and must be part of an active treatment plan directed at a specific outcome.
- The patient must have the capacity to learn from instructions.
- Medical treatment may generally require up to 12 visits in 4 weeks. Coverage beyond 12 visits in 4 weeks may require documentation supporting the medical necessity of continued treatment.
- Documentation must relate the training to expected functional goals that are attainable by the patient.
- The medical record should document the distinct goals and service rendered when self-care/home management training is done during the same visit as gait training (97116), orthotics fitting and training (97504) or prosthetic training (97520).
97535 CPT code represents self-care/home management training including (e.g., activities of daily living (ADL) training, compensatory training, going over safety procedures/instructions, meal preparation, and use of assistive technology devices or adaptive equipment. The six basic ADLs include eating, bathing, dressing, toileting, transferring, and continence. You can also use this code for teaching wound care techniques, strategies for edema control, safe sleeping positions, use of a home tens unit, traction, or paraffin device, activity modification, setting up a safe home environment, basic household cleaning/chores, and for education on the signs of infection. You can also include transfer/transition training in this code if the patient is having trouble getting up out of a chair, but not if you are using sit to stand for strengthening.
This code is typically reimbursed at a higher rate than TA, TE, NMR, and MT. This is due to the fact that you cannot teach self-care with a ‘hands-off’ approach. You must be actively lecturing, demonstrating, and providing literature in order to appropriately perform the tasks required by this CPT code.
As long as you are working on any of these activities with your patient’s exercise program, you can bill this code. Some of these exercises may include functional IR and ER training (dressing, toileting), fine motor skills (manipulating utensils), pelvic floor muscle exercises (for continence), sit to stand, and improving posture/deep cervical flexor endurance to ensure safe and effective swallowing. You should not be reporting treatments that are focused on any of these ADLs if the patient has no problem with performing them or if you already included them in the count for your other codes.
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.