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PTA Blog Talk

Coded Right

Published December 1, 2010 10:13 PM by Jason Marketti

Code 97535 is for self care and home management training, yet I seldom see this code billed for physical therapy services. In therapy, we assess and educate patients for safety procedures, adaptive equipment and compensatory training to assist patients to gain their highest level of function when at home. Since we do this, perhaps we should ensure our documentation supports our treatments and is appropriately coded for the skilled treatment we provide.

I see too many therapists do excellent work with patients for balance training, fall recovery, patient education for safety and sequencing with preventive strategies if a fall does occur as well as instruction with adaptive devices, yet bill therapeutic activity or therapeutic exercise for their skilled service.

Often it is the PT who enters the codes to be billed for services and maybe because of the way code 97535 is described, many assume incorrectly the code is for OT services only. It is similar to the constant diagnosis code of 719.7 (difficulty walking). Is there not another code that might more accurately describe a patient's therapeutic diagnosis?

I know time management has a lot to do with it but the scrutiny we are under with our documentation and ability to appropriately apply our knowledge should come across with the coding for patients. Just as our hands-on treatments should reflect what billing codes to use for those sessions.

2 comments

The problem we run into at our facility is that many insurances do not reimburse for the self care/home management code, so we are forced into billing therapeutic exercise.  I would be interested to know if this is the case with other facilities.

Juli Hunt, Physical Therapy - Clinical Director, Leonardo Physical Therapy December 3, 2010 3:26 PM
Wilmington MA

Good point Jason. I think you hit the perverbial nail on the noggin when you said time is the issue. Even I, as the Director, find it much easier and time-saving to use the more familiar codes than to worry too much about if this code is better than that. When it's 4:30PM and you find your 7:30AM patient's chart at the bottom of the pile on your desk, you just want to bolt and make sure the written note is accurate as to what you did. Don't get me wrong...you are 100% correct, but the more complicated things become, the harder it is to adhere to performing at a top level in all facets of your job, and there is no way you will ever cut the patient short, so the corners of paperwork get trimmed. Keep up your ideals - Al D.

Al DiMicco, Ortho - Director of PT, OSA December 1, 2010 10:38 PM
Bessemer AL

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About this Blog


    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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