2017 New Physical Therapy Evaluation Codes – Final Rule

2017 New Physical Therapy Evaluation Codes

Here comes 2017 and we have 3 New Physical Therapy Evaluation Codes. CMS has proposed a new physical therapy codes for 2017 as part of the Medicare Physician Fee Schedule (CMS-1654-P) proposed rule for 2017 .

We have now the:

2017 New Physical Therapy Evaluation Codes

Key Points:

  1. Each of these codes are not “time-based”; typical time is used as a guidance only
  2. Complexity (low-medium-high)
  3. Therapy Evaluation encounter MUST meet Medical Necessity and clearly documents FUNCTION
  4. Use these new therapy evaluation codes for Medicare and commercial payers; Workers’ Comp and MVA liability may still be using 97001/97002
  5. CPT Code 97001 is DELETED and REPLACED by 3 new physical therapy evaluation Codes
  6. CPT Code 97002 is DELETED and REPLACED by one single re-evaluation code

These New Physical Therapy Evaluation Codes has

4 Components of Complexity and Severity:

  1. Patient Medical and Functional HISTORY, which includes relevant comorbities and personal factors;
    • Comorbities/pre existing conditions that affects function and ability to progress through a plan of care
    • History of Functional limitation(s) and level; current functional level, abilities and limitations
    • Identify and Document Personal Factors that may impact the plan of care for Physical Therapy treatment; eg. age, gender, social history, education background, lifestyle, coping styles, job/profession, present/past experience. Document the overall behavior patterns including experience with disability
      • Existing personal factors that will not impact the plan of care should not be used when selecting the level of service
  2. Examination of body system(s) using standardized tests and measures;
    • Body Structures: Anatomical or structural parts of the body, eg., the organs, limbs and their components, classified according to the body systems;
    • Body Regions: Includes the Head, neck, back, lower extremities, upper extremities and trunk
    • Body Systems:
      • Musculoskeletal (range of motions, strength, weight/height, symmetry)
      • Neuromuscular (coordinated physical/body movement which includes gait transfers, locomotion and transitions) and motor functions on control and learning
      • Cardiovascular Pulmonary (RR, HR, BP and Edema)
      • Integumentary (skin integrity, texture, presence of scar formation)
    • Review of Systems should also include orientation of person, place and time; consciousness, the ability to express/show needs, anticipated emotional and or behahavioral responses
  3. Clinical Presentation of the patient
    • Stable and uncomplicated, OR
    • Evolving clinical presentation with changing clinical characteristics OR
    • Evolving clinical presentation with unstable and unpredictable characteristics
  4. Clinical Decision Making (based including the utilization of standardized patient assessment tools and or using the Functional Outcome measurable assessment result

The codes are based in large part on the amount of time and complexity involved in the evaluation. See below identifies the new physical therapy codes for 2017 and gives the long-form description of each code.

2017 New Physical Therapy Evaluation Codes

 CPT Code 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 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.

CPT Code 97162

Physical therapy evaluation: moderate complexity, requiring these components:

  • A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care;
  • An examination of body systems using standardized tests and measures in addressing a total of three 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 the patient and/or family.

CPT Code 97163

Physical therapy evaluation: high complexity, requiring these components:

  • A history of present problem with three or more personal factors and/or comorbidities that impact the plan of care;
  • An examination of body systems using standardized tests and measures addressing a total of four or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
  • A 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.

2017 New Physical Therapy Codes for Re-Evaluation

CPT Code 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; as is a
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.

These new codes are all untimed codes, and when recording time for Medicare, the minutes allocated for the evaluation are tallied as part of the “total treatment minutes,” which includes timed codes and untimed codes.

Since these codes are untimed codes, the time (minutes) rendered during the evaluation are now part of the “total minutes” of treatment time – this includes both the untimed and timed codes.

How about the CMS Reimbursement?

The 3 New Physical Therapy Evaluation codes are being reported based on its Complexity, they are priced based on a group than per code. Reimbursement is the same on each level/code.

Additional guiding factors include coordination, consultation, and collaboration of care consistent with the nature of the problem and the needs of the patient. I always recommend to never miss reporting a referring physician on Box 17 of the HCFA 1500 claim form.

** The Medicare therapy cap has increased from $1960 in 2016 to $1980 in 2017. And the 2017 Medicare conversion factor is $35.88, a $0.05 increase from 2016.

Need help?  Contact us here.

Searched keyword: 2017 New Physical Therapy Evaluation Codes

References:

 

Searched Keywords:
pt new eval codes, occupational therapy cpt codes, physical therapy cpt codes 2017, cpt code 97140, cpt code 97530, cpt code 97001, cpt code 97112, cpt code 97535, cpt code 97014, revenue cycle management, how much is clinicient, how much is webpt, webpt versus clinicient, webpt review, webpt documentation, webpt reviews, why use webpt, webpt versus clinicient, cpt 97001, 2017 new, physical therapy codes, out of network physical therapist, out of network doctor, out of network provider, billing functions for physical therapy, looking for physical therapy billing service, physical therapy billing service in new jersey, billing percentage, how to bill physical therapy, modifier go, modifier kx, medicare physical therapy cap, 97110 cpt, cpt 97140, cpt code 97112, cpt code 97116, cpt 97001, physical therapy cpt codes, cpt code 97035, cpt code 97014, cpt code 97535, medicare pt audit, how to bill medicare for pt, how to bill medicare for physical therapy, how to start a pt practice. how to start a physical therapy practice, physical therapy credentialing, rcm

 

 

pinky-maniri

Need help with your billing?

I can help you! Contact me today! CLICK HERE!

Dig Deep, Dig Deeper, Still Deeper ... until you find what you are looking for.

Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

Share This Post On