Eli's Rehab Report

97537 vs 97799:

Here's How to Code Workplace Assessments

Published on Mon May 08, 2006 Updated on Mon May 08, 2006

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Reviewed on April 24, 2014

Don't let state requirements trip you up

When a physiatrist bills for general workplace assessments, you should ask two questions: Did the physiatrist assess the workplace in general? Or did the physiatrist work with a specific worker to correct her job site or job tasks so the patient can recover more quickly from a work-related injury? The answer will help you decide which code to use.

Assess Your 97537 Skills

Typically, if the documentation specifies a general workplace assessment, you would not use 97537 (Community/work reintegration training [e.g., shopping, transportation, money management, avocational activities and/or work environment/ modification analysis, work task analysis, use of assistive technology device/adaptive equipment], direct one-on-one contact by provider, each 15 minutes). In most cases, report this code only when you train an individual patient one-on-one for re-entering work or the community.

Unless your state workers' compensation commission says otherwise, for general ergonomic assessments such as evaluation of an entire office for desk height, monitor height, chair type, keyboard position, etc., you may use CPT 97799 (Unlisted physical medicine/rehabilitation service or procedure) with detailed documentation.

Example: If one worker develops carpal tunnel syndrome, and a therapist offers her treatment and reintegration training after evaluating the ergonomics of her job, you would use 97537--assuming that the service would be processed through the employer's workers' comp policy.

But if a company has 10 workers who develop carpal tunnel syndrome, and the company wants a specialist to assess the workplace for potential causes, you wouldn't use 97537, says Chad Towner, PT, vice president of RediMed/Business Health Services in Ft. Wayne, Ind. "So one of the questions I often ask companies when they call me is, 'Do you have an open work comp claim, or is this something where you want me to look at the job in general to reduce potential work-related-injury risks?' "

Tip: Don't get hung up on the word "assessment." Instead, think of the difference between a preventive action for the general workplace and a rehabilitative service for an individual with a work-related injury. The services described by 97537 may involve an ergonomic assessment, but that assessment is only a small step in a worker's reintegration process.

When in Doubt, Check With Your State Agencies

Now here's the snag: Because each state differs in its workers' comp rules and regulations (usually a state-agency program interprets codes, sets fees and establishes guidelines), some may actually use 97537 for a general ergonomic assessment because no other related code exists. Meanwhile, others may have no recommendation at all.

Still, your state may suggest something completely different. For example, Texas uses the unlisted-procedure code 97799 with the modifier JA for "job analysis," says Bubba Klostermann, OT, CVE, CEAS, CEO of Work & Rehab of Abilene, Texas.

Note: Check out the Web site www.dol.gov/owcp/dfec/regs/compliance/wc.htm for a list of each state's home page and workers' compensation agency pages.