Coding Questions: Documenting activities of daily living

Published: 2009-11-01 20:15:39
Author: Marty Kotlar | Chiropractic Economics | April 2008

Q: I provide patients self-care home recommendations and information on how to modify their activities of daily living (ADLs) from an ergonomic and injury prevention point of view. Can I bill for this type of work?

A: You can charge patients and insurance companies for this type of service using CPT code 97535.
CPT code 97535 is self-care/home-management training (such as ADL and compensatory training, meal preparation, safety procedures, and instructions in the use of assistive technology devices/adaptive equipment) with direct, one-on-one contact by the provider, each 15 minutes.

This should be reported for the provider/therapist devoting a separate and distinct procedural service to the patient for the purpose of instructing the patient in managing an injury at home and preventing a secondary injury, and instructing the patient on how to prevent future exacerbations.

CLINICAL EXAMPLE

Examples of ADL instruction include showing patients how to retrieve items off the floor, lift pots from the stove, reach for items in cupboards, open drawers, and perform exercises to help hasten the healing process.

The following clinical example, courtesy of the American Medical Association (AMA) illustrates CPT code 97535:

A 65-year-old woman was recently discharged from the hospital with a diagnosis of cerebral vascular accident (CVA) resulting in a right hemiparesis. The patient lives alone and wants to be able to remain in her home.

The initial evaluation revealed performance deficits in bathroom activities and meal preparation. At the home site, the provider/therapist recommends and sets up the proper adaptive equipment in the bathroom, so the patient can safely transfer to toilet and bathtub by using compensatory techniques.

In the kitchen, the provider/therapist teaches and observes meal preparation that use one-handed techniques and special adaptive equipment. The provider/therapist must assure that the patientís functional level is sufficient to perform necessary self-care and home-management activities within safe limits.

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