Therapeutic activities for physical therapy

Therapeutic activities are one category of intervention used frequently by physical therapists. If you are a physical therapist working with patients, however, you may be wondering if you are using this code correctly. In this article you will learn more about the code for therapeutic activities including the what, when and why of billing this code.

Why are therapeutic activities important?

One of the primary aims of a physical therapist is to improve function. What is the purpose of improving a client’s range of motion, decreasing their pain and improving their strength? It is ultimately to improve their ability to perform daily activities, or their function. Therapeutic activities is a category of intervention wherein practicing a functional task itself is the intervention. We know as physical therapists that specificity of training is important and that whole practice of a functional task is necessary at some point in rehabilitation and this category of interventions is available just for this purpose.

The basics of billing for therapeutic activities

Therapeutic activities are billed using the CPT code 97530 (Therapeutic Activities). This is a timed code, meaning it is subject to the Medicare 8-Minute Rule. It is utilized to account for time spent performing dynamic activities used to promote improved function. Because of its dynamic nature, a therapeutic activity typically utilizes multiple parameters at the same time. For example, there may be components of strength, range of motion, balance, endurance and motor control that are all being addressed during a given activity.

You have probably noticed that a single intervention can often fall within more than one billing code. For example, a straight leg raise may be considered a therapeutic exercise under one condition and neuromuscular re-education under another. The aim of the intervention can help you decide how to bill for it.

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To help you better understand therapeutic activities, let’s look at some interventions that can be billed using this code:

Sit to stand: This task is dynamic in that the center of the patient’s mass is moving throughout their base of support as they move from a seated to a standing position and back.

If the goal of this intervention is simply to improve the gluteus maximus strength then it would be more appropriate to bill this intervention under therapeutic exercise.

If the goal of this exercise is to improve function, however, this intervention could easily fall under therapeutic activities. In this case, the aim might be to address functional weakness in a patient who cannot stand up from a chair without help or get up from the floor easily. It could also be used to address balance impairments during transfers or endurance deficits impairing the ability to complete functional tasks.

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Transfers: Transfers are another example of a functional therapeutic activity. Transfers can include getting in and out of a car, up and down from a chair, onto and off of the floor and many other surfaces. Transfers require strength, range of motion, endurance, balance and motor control and often benefit from blocked or random practice of the transfer itself.

Bed mobility: Improving independence in bed mobility can be an excellent goal. Practicing bed mobility can be used to improve bed mobility itself and can be a functional task used to improve strength, motor planning, and so forth, for other functional tasks.

Sport-specific training: In sport rehab there comes a time when it is important to practice sport-specific activities. Like the tasks listed above, a sport-specific intervention can be considered a therapeutic activity when it is dynamic and functional, such as doing running, jumping or throwing drills. In the case of sport-specific activities many components of movement such as strength, balance and motor control will be challenged.

These are just a few examples of therapeutic activities. How do you know which therapeutic activities to select for your patient or when to use therapeutic activities? Here are some guidelines:

Does the patient have the components necessary to perform the functional task? Selecting an appropriate therapeutic activity requires an understanding of the patient’s available ROM, strength, endurance, cognition and so forth. While the patient will undoubtedly make errors when first practicing this skill, you want to make sure it is safe and appropriate for their current level of function.

How does it relate to their goals? If the goals of your intervention are to address upper extremity range of motion, strength and coordination for example, be sure to choose a functional task that challenges these components.

Make it specific: Your patient will report functional tasks that are limited, that is likely what brought them into therapy in the first place. Find out what these tasks are and tailor your therapeutic activities to address components of these functional tasks and eventually, practice the task itself whenever possible.

Make it salient: Select activities that are meaningful and important to your patient. While you may not be able to practice hiking activities right away, for example, you can practice step ups or walking on uneven terrain while explaining to the patient how this activity translates to their ultimate goals.

Make it intense: Remember intensity is an important component of neuroplasticity. Ideally you will set up a functional task that the patient can attempt or complete many times. If it is too difficult you may not get enough practice to promote positive neuroplasticity.

Don’t forget to document

Like all billing, your documentation must justify the use of this code. Create functional goals in the plan of care. Be sure to document the patient’s functional limitations and how the therapeutic activities you selected address those limitations. This will help define whether these procedures are reasonable and necessary. Medicare requires a reassessment of the patient and their progress at least every 10 visits. During your initial evaluation and reassessments you must provide objective measurements of loss of ADL’s, balance, strength, coordination, mobility, etc. and their effect on function as well as why a skilled provider like a physical therapist is needed to address this limitation in function.

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Resources

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