How To Use CPT Code 97537

CPT 97537 describes the community/work reintegration training provided by a healthcare professional to help patients with disabilities or injuries return to employment and the community. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97537?

CPT 97537 can be used to describe the direct one-on-one training and support provided by a healthcare professional to help patients reintegrate into the community and workplace after a disabling injury or illness. This code is used when the provider spends 15 minutes working with the patient to assess job demands, provide adaptation training, and analyze the worksite and community environment to recommend assistive devices.

2. Official Description

The official description of CPT code 97537 is: ‘Community/work reintegration training (eg, 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, each 15 minutes.’

3. Procedure

1. The healthcare professional assesses all components of the job demands relevant to the patient’s ability.
2. The provider determines the type of adaptation the patient needs and trains them in the use of equipment such as wheelchairs, raised toilet seats, and handwriting aids.
3. The provider analyzes the worksite and community environment to identify factors that could negatively impact the patient’s balance, stability, and posture.
4. Based on the analysis, the provider recommends the most appropriate assistive devices for the patient.
5. The provider spends 15 minutes working one-on-one with the patient, providing training and support to help them reintegrate into the community and workplace.
6. Additional sessions may be scheduled as needed to ensure the patient’s successful reintegration.

4. Qualifying circumstances

Patients eligible to receive CPT 97537 services are those with disabling injuries or illnesses who require assistance in returning to employment and the community. The healthcare professional must provide direct one-on-one contact with the patient for each 15-minute session. The training may include activities such as shopping, transportation, money management, avocational activities, work environment/modification analysis, and work task analysis. The provider may also use assistive technology devices or adaptive equipment to support the patient’s reintegration.

5. When to use CPT code 97537

CPT code 97537 should be used when a healthcare professional provides direct one-on-one training and support to a patient for each 15-minute session. This code is appropriate for patients who require assistance in reintegrating into the community and workplace after a disabling injury or illness. It should not be used for wheelchair management/propulsion training, which has its own specific code (97542).

6. Documentation requirements

To support a claim for CPT 97537, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for community/work reintegration training
• Specific activities and tasks addressed during the training sessions
• Date, start and end time of each 15-minute session
• Assistive devices or adaptive equipment recommended or used
• Progress made by the patient and any additional sessions scheduled
• Signature of the healthcare professional providing the service

7. Billing guidelines

When billing for CPT 97537, ensure that the healthcare professional provides direct one-on-one contact with the patient for each 15-minute session. It is important to follow the specific guidelines for reporting this code and not to report it with other codes unless necessary. Consider the location of the training and the use of assistive devices when coding this service.

8. Historical information

CPT 97537 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code over the years, with the most recent update occurring on January 1, 2013.

9. Examples

1. A physical therapist working one-on-one with a patient to provide community/work reintegration training, including shopping and transportation skills.
2. An occupational therapist training a patient in money management and avocational activities to support their return to employment and the community.
3. A rehabilitation specialist analyzing a patient’s work environment and providing work task analysis to help them successfully reintegrate into their job.
4. A healthcare professional recommending and training a patient in the use of assistive technology devices to support their community/work reintegration.
5. A therapist providing direct one-on-one contact with a patient, teaching them adaptive techniques for work environment modification and analysis.
6. A provider working with a patient to develop strategies for managing their disability in the workplace and community.
7. A healthcare professional training a patient in the use of adaptive equipment to improve their ability to perform job tasks.
8. A therapist providing direct one-on-one contact with a patient, teaching them skills for managing their disability during avocational activities.
9. A provider analyzing a patient’s worksite and recommending modifications to support their successful return to employment.
10. A healthcare professional working with a patient to develop strategies for managing their disability during transportation and shopping activities.