Occupational therapy coding focuses on restoring functional independence through therapeutic activities, ADL training, and cognitive rehabilitation. This page covers the top ICD-10 diagnosis codes and CPT procedure codes used by occupational therapists and OT practices across the US.
97535 (self-care/home management training) requires documentation of the specific ADL or IADL being trained — vague notes stating ‘ADL training performed’ are the top audit trigger for OT claims.
OT evaluation codes (97165–97167) replaced 97003/97004 in 2017 — do not use the older codes.
Medicare does not cover maintenance therapy — document restoration of function, not just maintenance of current status, to support continued OT coverage.
In 2017, CMS replaced 97003 (OT evaluation) with three complexity-based codes: 97165 (low complexity), 97166 (moderate complexity), and 97167 (high complexity). The complexity level is based on the occupational profile, analysis of occupational performance, and clinical decision-making required.
What is the ICD-10 code for ADL deficits after stroke?
G81.10 (Spastic hemiplegia, unspecified side) or G81.90 (Hemiplegia, unspecified) are commonly used. Add Z87.39 or a sequela code (S prefix with 7th character ‘S’) for residual conditions from prior stroke. Document the specific functional deficits to support medical necessity.
Can OT bill for sensory integration therapy?
Yes. 97533 (Sensory integrative techniques) covers sensory integration therapy. It is time-based (15-minute units) and requires documentation of the sensory processing deficits and response to treatment.
When is 97535 vs 97530 used?
97535 is specific to ADL training and home management skills (dressing, bathing, meal prep). 97530 covers broader therapeutic activities that simulate work or daily tasks but are not ADL-specific. Both require direct one-on-one contact and are billed in 15-minute units.
How does OmniMD support OT documentation?
OmniMD’s OT module includes standardized assessment tool integration (FIM, COPM, AMPS), functional goal-setting templates, and outcome tracking dashboards to support both clinical care and Medicare documentation requirements.
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