Basics of 97535 CPT code

A healthcare provider is required to give  proper instruction to a person especially in cases of recovery from acute disease. Below is the description of 97535 CPT code.

97535 – Self-care/home management training (eg, 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

CPT code 97535 is a code used for self-care/home management training, focusing on activities of daily living and compensatory training.

Self-care or home management training CPT code comprises training activities of daily living. There are six basic ADLs including:

•         Eating
•         Bathing
•         Dressing
•         Toileting
•         Transferring
•         Continence

These services are aimed at helping patients improve their ability to perform activities of daily living (ADL) and compensatory training, such as meal preparation, safety procedures, and instructions in the use of assistive technology devices or adaptive equipment. CPT code 97535 is billed in 15-minute increments, with each additional 15 minutes reported separately.

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 that your treatments 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. Teaching a home exercise program that focuses on improving ROM, flexibility, strength, or endurance falls under the therapeutic exercise code.

Read also: Coding guide 8 minute rule for Physical therapy CPT codes

Documentation required for 97535 CPT code

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.

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 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).