For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The new evaluation codes are based on patient complexity and level of clinical decision making (low, moderate or high complexity). Code set 97161-97164 is used for PT, while 97165-97168 is for OT.
In terms of physical therapy, at a minimum, physical therapy evaluations should include the following:
Clinical decision making
Development of plan of care
As for 97164, this would be reported for performance of patient re-evaulation that is based on an established and current plan of care.
Below are the definitions of the body regions and systems that CPT has defined:
Body regions: head, neck, back, lower extremities, upper extremities, and trunk
Body systems: musculoskeletal, neuromuscular, cardiovascular pulmonary, and integumentary.
A review of body systems includes the following:
For musculoskeletal: the assessment of gross symmetry, gross range of motion, gross strength, height, and weight.
For neuromuscular: a general assessment of gross coordinated movement (e.g., balance, gait, locomotion, transfers, and transitions) and motor function (motor control and motor learning)
For cardiovascular pulmonary: the assessment of heart rate, respiratory rate, blood pressure, and edema
For integumentary: the assessment of pliability (texture), presence of scar formation, skin color, and skin integrity
CPT also states that "A review of any of the body systems also includes the assessment of the ability to make needs known, consciousness, orientation (person, place, and time), expected emotional/behavioral responses, and learning preferences (e.g., learning barriers, education needs)."
Personal factors: Factors that include sex, age, coping styles, social background, education, progression, past and current experience, overall behavior pattern, character, and other factors that influence how disability is experienced by the individual. Personal factors that exist but do not impact the physical therapy plan of care are not to be considered, when selecting a level of service.
There will be no change in the payment rates from 2016 into 2017 and no change between the code levels. Per the 2017 Medicare Final rule, "We proposed a work RVU of 1.20 for both the PT and the OT evaluation groups of services. We proposed this work RVU because we believed it best represents the typical PT and OT evaluation. This is the value recommended by the HCPAC for the OT moderate complexity evaluation and nearly the same work RVU for corresponding PT evaluation (1.18). Additionally, a work RVU of 1.20 is the longstanding value for the current evaluation codes, CPT codes 97001 and 97003, and thus, assures work neutrality without reliance on particular assumptions about utilization, which we believed was the intent of the HCPAC recommendation."
Besides physical and occupational therapy changes a few other big changes to CPT for 2017 include: the separate reporting of moderate sedation, changes to the requirements for chronic care management, expansions to telehealth services, vaccines, laboratory testing, and many more.
With 148 new codes, 81 deletions, and 498 revisions- 2017 is shaping up to be a whole new year!
This Week's Audit Tip Written By:
Misty Tinch, RHIT, CPC, CPMA
Misty is a Compliance Consultant for our parent organization, DoctorsManagement, LLC
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