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Self-Care Training
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Question: I just saw a patient who was recently confined to a wheelchair following a car accident. He was able to propel the wheelchair, but he wasn’t sure how to reach items on high shelves or walk his dog using the chair. I worked with him on these techniques for 30 minutes. Is this an appropriate use of 97535? I am familiar with this code, but I thought that mainly occupational therapists reported it.
Answer: Yes, you should report two units of 97535 (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 by provider, each 15 minutes) for your services.
Tip: Some Medicare carriers’ ADL policies state that it is not usually medically necessary to conduct more than 30 minutes of ADL training on any given day, unless you treat multiple traumatic injuries. Check with your carrier before you bill any ADL service so you can determine appropriate time limitations.
Although some therapists refer to 97535 as an occupational therapists’ code, most states allow PTs to report this code as well. PTs may find themselves working on therapeutic exercises or other modalities with patients who also require ADL training, and if the physician orders it, PTs can usually perform ADL training as part of the plan of care.
Potential snag: Some coders and therapists may see “wheelchair training” in the chart and instantly assume that 97542 (Wheelchair management/propulsion training, each 15 minutes) is correct for a situation like yours. You should report 97542 when you train patients on how to use their wheelchairs (such as how to get in and out of it or how to use the brake), or when you evaluate a patient to match him with an appropriate wheelchair.
If you assist a wheelchair-bound patient with compensatory techniques to facilitate ADL, you should use 97535 instead. You might report 97535 if you teach the patient how to cook from the seated wheelchair position, or how to use reaching equipment for items placed high on grocery-store shelves.
You should check your state regs to see if their provider i.e. a non-Occupational Therapist is allowed to provide these services if they are concerned.
Resource: See www.apta.org/Licensure/StatePracticeActs/
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