Do you provide patients with information on how they should modify their normal daily activities from an ergonomic and injury prevention point of view? Can you bill patients or insurance companies for this type of work?
The answer is absolutely YES. You can charge patients and insurance companies for this type of service. The CPT code that most accurately describes this procedure is 97535.
CPT code 97535 is self-care/home management training (i.e., activities of daily living and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes.
This should be reported for devoting time to provide a separate and distinct procedural service to the patient for the purpose of the following:
~ Instructing the patient in managing an injury at home and preventing a secondary injury
~ Instructing the patient on how to prevent future exacerbations
Examples of ADL instruction include showing patients how to pick items off the floor, lifting pots from stove, reaching items in cupboards, opening drawers and exercises to help hasten the healing process.
Documentation for CPT code 97535 should relate the ADL instruction to the patient’s expected functional goals and indicate that it is part of an active treatment plan directed at a specific goal.
Some common diagnoses codes that “link to” or “combine with” 97535 are the following:
723.4: Cervical radiculitis
724.1: Thoracic spine pain
724.4: Thoracic or lumbosacral neuritis or radiculitis, unspecified
719.7: Difficulty in walking
724.3: Sciatica
724.6: Lumbosacral or sacroiliac pain, instability, ankylosis
I am a firm believer that if you provide a service to your patients, you should bill for that service. You should incorporate 97535 into your treatment plans if clinically indicated.
WHAT IS THE APPROXIMATE FEE SCHEDULE ASSOCIATED WITH THIS CPT CODE? MEANING HAOW MUCH SHOULD I BILL INSURANCE FOR THIS ASSOCIATED CPT CODE?
Amy, the appropriate fee depends on several things. First it would depend on the area that you are providing the service and/or the allowable from the insurance carriers. Of course, dual fee schedules are a no-no, so you would have to find a comfortable 'average' for you. If you would like to discuss this further feel free to contact me at 866.933.1381 x704. Hope this helps.
2010 Fee schedule says up to $61.02 insurance company allowing $48.82
How many times are we allowed to bill this 97535 code.. If lI see a pt 3x wk for 2-4wks, and I explain these on every visit, is it safe to bill these on every visit.
97535 – Self care/home management training (e.g. ADL (activities of daily living) and compensatory training, meal preparation, safety procedures and instruction in the use of adaptive equipment
This is one of the codes, I would inquire about coverage detail when completing a verification of benefits. Be sure to let the CSR (customer service representative)know that you are calling from a Chiropractic office and the Chiropractor will be billing this service. Some of the plans will NOT cover this service if billed by a Chiropractor.
Should you receive the ok to bill, I would monitor the use of this code and the reimbursement.
In short, I would ‘go lightly’ when billing this code. Perhaps upon initial care and then when performing re-exams.
The answer os obviously NO! You can bill once. If you tell them again without modifying your procedure, it is simply redundant and not billable.
Is giving “Self care or home management PT sessions” to late stage Alzheimer’s patients in nursing homes appropriate? Our Medicare account was billed for 59 of these treatments.