As a writer for McKnight’s, I find nothing more gratifying than when I receive questions from readers seeking more clarification and guidance after a blog.
We came to you at the beginning of November with exciting news that three new caregiver training CPT codes were finalized for calendar 2024.
Wow, did the inquiries come in!
Folks are clearly thinking about how they can provide these services and I am here today to answer the top questions I have received from you all since that release.
Let’s start with the basics.
Question
What are the new CPT codes and how are they defined?
Answer
97550 — Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face-to-face; initial 30 minutes.
97551 — Each additional 15 minutes (List separately in addition to code for primary service).
97552 — Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers.
Question
What is the “skill,” to say what does my intervention need to include and what must my documentation support to use these?
Answer
During a skilled intervention, the caregiver(s) is trained using verbal instructions, video and live demonstrations, and feedback from the qualified healthcare professional on the use of strategies and techniques to facilitate functional performance and safety in the home or community without the patient present.
Skilled training supports a caregiver’s understanding of the patient’s treatment plan, ability to engage in activities with the patient in between treatment sessions, and knowledge of external resources to assist in areas such as activities of daily living (ADLs), transfers, mobility, safety practices, problem solving and communication.
Question
Do I need to identify this area of care on my treatment plan?
Answer
Yes, the expectation that a patient-centered treatment plan should appropriately account for clinical circumstances where the treating practitioner believes a caregiver’s involvement is necessary to ensure a successful outcome for the patient and where, as appropriate, the patient agrees to caregiver involvement.
Now, to the more specific areas you all are asking…
Question
Renee, what is a caregiver? How does the Centers for Medicare & Medicaid Services define this?
Answer
In CMS’s ongoing education and outreach work on the use of caregivers in assisting patients they have broadly defined a caregiver as a family member, friend or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.
After considering the public comments, they finalized a revised definition of caregiver to be “an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability or functional limitation” and “a family member, friend or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.”
Question
OK, so how often does the caregiver need to be involved in care every day?
Answer
A caregiver is an individual who is assisting or acting as a proxy for a patient with an illness or condition of short or long-term duration (not necessarily chronic or disabling); involved on an episodic, daily or occasional basis in managing a patient’s complex healthcare and assistive technology activities at home; and helping to navigate the patient’s transitions between care settings.
Caregiver understanding and competence in assisting and implementing these interventions and activities from the treating practitioner is critical for patients with functional limitations resulting from
various conditions.
Question
We are hearing that patients must consent? How is this accomplished when my patient is cognitively impaired?
Answer
You are correct. CMS states that they are finalizing, as proposed, that the patient’s (or representative’s) consent is required for the caregiver to receive Caregiver Training Services (CTS) and that the consent must be documented in the patient’s medical record. The reason to require the patient’s (or their representative’s) consent for CTS is because, unlike most services, the patient would not be present for the service.
CMS believes it is be important to make the patient aware, out of concern for patient privacy, that the service is furnished outside their presence and that any applicable cost-sharing would be
their responsibility.
Question
So, can we use general consent?
Answer
CMS leaders state they do not believe that the general consent to receive treatment would be sufficient to make a patient aware of the unique circumstances under which CTS are furnished.
For these same reasons, they continue to believe it is appropriate to require a specific consent for
CTS. The term “consent” as opposed to other recommended terms to remain consistent across other codes with consent requirements across the PFS.
In cases of an Alzheimer’s or dementia diagnosis, it is encouraged providers obtain consent from the patient or their representative for CTS as early as possible in the diagnosis.
In closing, the unveiling of these codes not only addresses your queries but opens a pathway for a more comprehensive and collaborative approach to patient care, ensuring that caregivers are equipped with the tools and knowledge necessary for fostering optimal patient outcomes.
As we move forward, let us embrace these changes with a commitment to enhancing the quality of care and support for both patients and their dedicated caregivers.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab. Additionally, she serves as a member of American Speech Language Hearing Association’s (ASHA) Healthcare and Economics Committee, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
Have a column idea? See our submission guidelines here.
