Part B Insider (Multispecialty) Coding Alert

Question: We have documentation for three patients, all knee amputees, who were recently fitted with lower-limb prostheses. The therapist performed activities of daily living (ADL) training, which included stump management techniques, for a total of 60 minutes. The therapist also instructed each of the patients one-on-one for 10-12 minutes to accommodate their individual needs during this 60-minute demonstration. Which codes should I report in this case?


North Carolina Subscriber

Answer: You’d report one unit of CPT Codes 97353 and one unit of 97150 (Therapeutic procedure[s], group [2 or more individuals]) for the balance of the 60-minute period for each patient. A therapeutic procedure, by definition, is a way to effect change by applying clinical skills and/or services that attempt to improve function. In other words, you’d report this code combination three times, once for each patient the therapist worked with.

Why: This group has both the knee amputation and prostheses in common, so you can use this as the unifying element necessary to report the group code (97150). Also, the therapist has direct on-on-one contact with each individual patient for 10-12 minutes, so you can report the ADL code (97535).