Just four new codes...seems easy, right? The truth is, this new evaluation code law for 2017 has a little more going on just below the surface. The standards of an evaluation will remain the same. The real curve-ball here is the newly added system to classify complexity. Physical therapists have four components to consider, and each level of complexity has criteria for elements from each. (Are you a Physical Therapist? Click here) Here’s a quick breakdown:
1. Occupational Profile and Medical & Therapy History
An occupational profile gives an overall picture of the client’s experiences, daily living, and their problems performing the occupations of their day to day life. The complexity level of the occupational profile depends on the extent of the client’s problems and their goals. Their medical and therapy history can include a brief, expanded, or extensive review of physical, cognitive, or psychosocial history. The key here is to only consider aspects of the patient’s history that directly impact the plan of care now.
2. Assessment of Occupational Performance
This determines “performance deficits” that cause activity limitations and participation restrictions. The last two might seem a little redundant, but there are subtle differences between them. The ICF defines activity limitations as “difficulties an individual may have in executing activities” and participation restrictions as “problems an individual may experience in involvement in life situations”. For more information on the ICF, you can reference the post here. In a low complexity assessment, you identify 1-3 deficits, 3-5 for a moderate, and in a high complexity assessment 5 or more.
3. Clinical Decision Making
Clinical decision making puts it all together. You will need to consider your analysis of the occupational profile coupled with the data from your assessments (which were either problem-focused, detailed, or comprehensive). You will also need to consider appropriate treatment options. For a low complexity case you should consider limited options, several for moderate and multiple for high. This is also when you consider how much, if any, modification or assistance was needed for the client to complete the evaluation. No modification corresponds to low complexity, minimal to moderate modification suggests a moderate complexity, and significant modification corresponds to high complexity.
Once you throw in the different requirements for each complexity level, this new coding system can get a little convoluted. That’s why we want to give you all the resources you need to be successful in 2017.Malcolm L. Bond, Ph.D. Cedaron’s Founder and Chief Scientist