At Mountain View Care Center, we questioned whether there is a correlation between the amount of activities of daily living (ADLs) the occupational therapy staff has been providing to patients with changes in their’ functional level upon discharge.  We chose to compare this by analyzing the percentage of ADLs billed in the facility with the change in CARE item set from admission to discharge.


We gathered Optima reports from all Bandera facilities to determine service code usage of self CARE ADLs (97535) as a percentage of total billable services for a three-month time period. Functional Outcomes report containing the change in OT Self CARE item assessment was obtained for the same three-month time period. These two reports were analyzed to determine if there was a correlation between the two sets of data.


The amount of billing of 97350 seemed to equate with the amount of change in CARE.  However, upon closer statistical analysis, this was not found to be the case. There was no correlation found between use of ADL billing code (97535) and improvement in CARE item set. Billing of the code 97110 had a negative correlation with the improvement in ADL scores.


  1. CARE item set and billing of ADL (97535) code
  2. Correlation between usage of billing codes and change in CARE item set









We concluded the following:

  1. The overuse of therapeutic exercise in OT treatment plans has a negative impact on patients’ improvement in functional levels.
  2. Occupational therapy should minimize treatments that involve purely therapeutic exercise in their daily treatment sessions.
  3. It would be more beneficial for the patients to address strength deficits through the use of ADLs and therapeutic activities than using upper body ergometry or tabletop activities.

In the future, we’d like to further our analysis by performing a study using a change in ADL levels instead of CARE to decrease concerns about CARE not being an accurate measure of improvement. Furthermore, after educating the staff on the increased use of ADLS as a modality, we’d like to perform the same analysis to determine if there was an increase in CARE item assessment as a result of increased ADL usage.

By Tonya Haynes, PT, DOR, Mountain View Care Center, Tucson, AZ