2017 Physical Therapy CPT Coding Updates

on . Posted in Coding Updates

Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted for 2017 and replaced with four new codes.

The new evaluation codes 97161-97163 describe services that range in complexity from low to high and have a code descriptor that has specific required components.  I have cited some of these requirements below from the new AMA 2017 CPT codebook however I do recommend that you review it as well.

#•97161  Physical therapy evaluation:  low complexity, requiring these components:

        •  A history with no personal factors and/or comorbidities that impact the plan of care;

        •  An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the      following:  body structures and functions, activity limitations, and/or participation restrictions;

        •  A clinical presentation with stable and/or uncomplicated characteristics; and

        •  Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

Typically, 20 minutes are spent face-to-face with the patient and/or family.

#•97162  Physical therapy evaluation:  moderate complexity, requiring these components:

        •  A history of present problems with 1-2 personal factors and/or comorbidities that impact the plan of care;

        •  An examination of body system(s) using standardized tests and measures in addressing a total of 3 or more elements from any of the following:  body structures and functions, activity limitations, and/or participation restrictions;

        •  An evolving clinical presentation with changing characteristics; and

        •  Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

Typically, 30 minutes are spent face-to-face with  he patient and/or family.

#•97163  Physical therapy evaluation:  high complexity, requiring these components:

        •  A history of present problems with 3 or more personal factors and/or comorbidities that impact the plan of care;

        •  An examination of body system(s) using standardized tests and measures in addressing a total of 4 or more elements from any of the following:  body structures and functions, activity limitations, and/or participation restrictions;

        •  An clinical presentation with unstable and unpredictable characteristics; and

        •  Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

Typically, 45 minutes are spent face-to-face with the patient and/or family.

For re-evaluation of physical therapy established plans of care, you would now utilize CPT 97164.

#•97164  Re-evaluation of physical therapy established plan of care, requiring these components:

        •  An examination including a review of history and use of standardized tests and measures is required; and
 
        •  Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome.
 
Typically, 20 minutes are spent face-to-face with the patient and/or family.

 

 

 

 

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