How to Correctly Use CPT Code 97535

No one loves to leave money on the table. No, I’m not talking about haggling with the used car salesman and feeling like they pulled the wool over your eyes; I’m talking about getting paid for all the services rendered by physical therapists, occupational therapists, and speech-language pathologists. In an era where every penny counts and insurance companies continue to cling to the archaic systems of fee-for-service, every minute counts in your treatment sessions as well. 

That need to account for every minute with a patient is why the Current Procedural Terminology (CPT) code 97535 is so important. CPT code 97535 is the code for self-care/home management training (i.e., activities of daily living and compensatory training, meal preparation, safety procedures, and instruction in the use of assistive devices/adaptive equipment technology), and its use can span a multitude of factors that in all likelihood you are already doing throughout a treatment session without the appropriate credit. Read on to find out how and why you should be using CPT code 97535 more often. 

What does CPT code 97535 entail?

CPT code 97535 is listed in the current CPT handbook (owned by the American Medical Association) as Self-Care/Home Management, which can apply to activities of daily living (ADLs) and compensatory training, meal preparation, safety procedures, and instruction in the use of assistive devices/adaptive equipment. Taken at face value, a clinician may read this definition to purely mean education in regard to activities of daily living and move on without a second thought. But more broadly, this code can—and should—be applied to several instances of treatment. For example, these include:

• Appropriate safety procedures,
• Transfer techniques (including energy conservation techniques),
• Joint protection strategies (e.g., surgical precautions or sleeping postures),
• Adaptive equipment training, 
• Home injury/symptom/pain management, and
• Compensatory strategies for home activities.

As you can see, these educational situations expand far beyond ADL training and can be used by PTs, OTs, and SLPs. Now, just think about the amount of time you spend talking with a patient or caregiver about one of the above activities. With a little bit of documentation to reflect medical necessity criteria, you can easily utilize CPT code 97535.

What are some clinical examples of using CPT code 97535?

In my own clinical expertise, not a session goes by where I do not at least mention some aspect of symptom or pain management. This can be something as simple as adjusting sleeping postures for a patient with cervical radiculopathy to a more complex situation of triaging pain at home during an active treatment plan and progression of function. 

When documenting for CPT code 97535, remember you must show medical necessity that reflects the need for a skilled therapist to deliver this intervention. To do this, include the concepts taught, any techniques utilized to teach the concepts, and the total time to deliver the intervention. Specifically, here are three examples of how to show medical necessity and defensibly document for CPT code 97535:

Self-Care/Home Management Training for a Patient with Cervical Radiculopathy

The patient received instruction for the correct use of a cervical pillow to maintain neutral cervical spine positions while sleeping in supine and side lying to reduce cervical radiculopathy symptoms and alleviate pain. The patient was cautioned against prone lying positions as this can exacerbate pain-related symptoms. Instruction was completed for a total of 8 minutes with live demonstration by the therapist and return demonstration by the patient.

Self-Care/Home Management Training for a Patient Returning to Running

The patient received instruction in mitigating tissue responses to the progressive loads experienced as she resumed her running activities. The patient was educated that not all types of pain require a cessation of activity to which she was given parameters of when to advance her running versus when to reduce the intensity. The patient was also instructed in pain management techniques beyond that of her home exercise program for any pain experienced prior to, during, or after running activity. Instruction was completed for a total of 10 minutes with verbal confirmation from the patient of understanding.

Self-Care/Home Management Training for Safety Procedures

The patient received instruction to cover safety procedures and joint protection to avoid bending past ninety degrees of hip flexion, crossing the involved leg past midline, and turning the involved leg into internal rotation to correctly follow their total hip arthroplasty precautions. After eight minutes of total instruction, the patient was able to demonstrate a modified independent status to the safety procedures.

Should CPT code 97530 be used for HEP instruction?

This question can potentially be a sticky one, so I will start by recommending you first consult your resident billing expert. In lieu of a billing expert, the next best option is to use common sense in the general make-up of your active treatment plan and home exercise program (HEP). The key word here is exercise, so if the HEP consists primarily of exercise that more closely aligns with the tenets of therapeutic exercises (CPT code 971100), therapeutic activities (97530), or neuromuscular re-education (97112), then you should use those codes when billing for any HEP instruction. However, if your HEP consists primarily of joint protection strategies sans any exercises, you could make the argument that 97535 would be better suited.

What other coding and billing tips are there for CPT code 97535?

CPT code 97535 is a time-based code, which means being able to use this particular CPT code will rely on the time you assign to the code. The general rules for using a CPT code for billing are determined by the insurance company and their payer rules. Often this boils down to the 8-minute rule or the Substantial Portion Methodology and the rule of eights. Each of these rules will determine how many units of a given CPT code you are able to use when billing for services rendered where the medical necessity for these services must be reflected in the medical record. 

That said, both of these rules allow for your allotted time for a given CPT code unit to be an aggregate. What I mean by this is if you complete five minutes of CPT code 97535 at the beginning of a session and conclude with another three minutes of the same code, then that totals eight minutes and it can be used for billing per the above rules. Just remember that many of the CPT codes used in rehab therapy require one-on-one contact so be sure your medical record reflects this.

Documenting and CPT coding is hard, so why not make it easier?

As rehab therapists, we spent the better part of two to three years learning the craft of physical, occupational, or speech therapy—and within those curricula, there is a level of instruction pertaining to documentation and CPT coding guidelines. But unfortunately, there remains a disconnect between what academia teaches and what really happens clinically in the real world. 

Too often I encounter students afraid to use CPT code 97530 for a squat exercise because one professor said that was fraudulent. Well, they were wrong, but that’s not the student’s fault—and there’s more to it than that. No healthcare provider goes to their respective school to be master coders or get an MBA. That’s why WebPT has the best purpose-built EMR focused on maximizing reimbursement, helping clinicians streamline their documentation workflows, and using AI to help with proper CPT coding. Take the headache out of documentation and have fun treating your patients with WebPT as your software partner.