New Physical Therapy Coding Updates for 2017

It’s time again to welcome the new year and with it, changes that will make our practices better than before. Among these changes? Physical Therapy codes.

Recently it was announced that the Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted, and four new codes have been released in their place. These codes will be effective by January 1, 2017.

The new evaluation codes (97161 to 97163) center around services ranging in complexity from low to high, each with a code descriptor specifying required components. To give you an idea of each new code, some of the requirements are stated below:

Code no. 97161 – Physical therapy evaluation: low complexity, requiring the following 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.
  • In this case, usually 20 minutes are spent face-to-face with the patient and/or family.

    Code no. 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.
  • In this case, usually 30 minutes are spent face-to-face with the patient and/or family.

    Code no. 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;
  • 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.

  • This usually takes 45 minutes face-to-face with the patient and/or family.
    In case of re-evaluation of physical therapy established plans of care, you would now utilize CPT 97164.

    Code no. 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.
  • Often in this case only 20 minutes are spent face-to-face with the patient and/or family.

    It’s evident that these new codes focus on complexity levels of evaluations, which means that therapists will have to be diligent in accurately identifying low, medium and high complexity. And of course, it would be best for therapists to review and understand the changes fully by looking at the new AMA 2017 CPT codebook.

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