Quite Simply, It's Complex: The Truth About Four New PT Evaluation Codes

Posted by Malcolm L. Bond, Ph.D. on Dec 15, 2016 9:07:24 AM


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 an Occupational Therapist? Click here) Here’s a quick breakdown:

1. Patient History

This includes comorbidities, their functioning level prior to what led them to seek care, relevant treatment approaches in the past, and various factors such as medications, work status, social history, and more. The key here is to only consider aspects of the patient’s history that directly impact the plan of care now.

2. Examination 

Includes body structure and function, 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”. Here’s a post for reference on what the ICF is all about. Activities and participation include- but are not limited to- mobility, self-care, domestic life, interpersonal interactions and relationships, and civic life.

3. Clinical Presentation 

The patient is stable and uncomplicated. This is your straightforward athlete with an ankle sprain- their ankle hurt the worst at time of injury, is getting better, and you can expect it to get better over time.

The patient has evolving clinical presentation with changing clinical characteristics. This patient could be someone who began treatment with neck and upper back pain and now also has numbness in the right arm and hand. The symptoms are evolving and definitely have the potential to get worse.

The patient has evolving clinical presentation with unstable and unpredictable characteristics. Take our back pain and hand numbness patient from a moment ago, and throw in orthostatic hypotension. There is a risk every time you have the patient change positions that their blood pressure can bottom out, ergo their blood pressure is unstable and unpredictable

4. Clinical Decision Making

The final piece of the puzzle. This is your judgement as a therapist based on the big picture of the patient regarding their treatment plan. It can be of low, moderate, or high complexity, and the decision must be made using a “standardized patient assessment instrument and/or measurable assessment of functional outcome”.

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Topics: 2017 New Evaluation Codes

3 Interfaces Every Hospital Outpatient Clinic Needs

Posted by Katelyn Rossi on Nov 29, 2016 3:39:28 PM


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Topics: Outpatient Rehab EMR, Interfacing

3 Reasons MIPS is More Important Than You Think

Posted by Katelyn Rossi on Nov 8, 2016 8:55:16 AM
New evaluation codes are not the only change right around the corner. CMS released the final 2017 Medicare and CHIP Reauthorization ACT (MACRA) in October, and the provision that should be on every therapists’ radar is the Merit-Based Incentive Payment System (MIPS). Why is it relevant now when it doesn’t even apply to therapists yet? Take a look.
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Topics: 2017 New Evaluation Codes

Choosing an EMR: 8 Must Have Tools

Posted by Chance Grossman on Oct 25, 2016 12:32:51 PM


When it Comes to Compliance.... not all EMRs are created equal.  In fact, most — despite their claims — lack the robust technology and tools needed to effortlessly manage today’s growing payee regulations.

Since many first-time technology adopters “don’t know what they don’t know,” we’ve listed some of the must-have technologies that your clinic will want to ensure compliance.

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Topics: 2017 New Evaluation Codes, ICD-10, ICF, CPT codes, changing evaluation codes

Get Invested in New Evaluation Codes

Posted by Malcolm L. Bond, Ph.D. on Oct 24, 2016 9:38:28 AM


      By now, you’ve probably heard the news. January 1, 2017 marks the end of physical therapy evaluation codes 97001 and 97002, and the beginning of brand new evaluation codes based on patient complexity. The two old codes, established in 1998, are being replaced by four new codes: 97161 for low complexity evaluation, 97162 for moderate complexity evaluation, 97163 for high complexity evaluation, and 97164 for re-evaluation. For the first time, physical therapists will have a coding system that reflects on the variation in the treatment provided for a patient based on how complex the patient’s needs are. There will be new Occupational Therapy evaluation codes as well following the same design, however the codes themselves and the relative values differ.

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Topics: 2017 New Evaluation Codes

Preparing for New Evaluation Codes: Get Back to the Basics

Posted by Katelyn Rossi on Oct 17, 2016 8:54:58 AM


               As we become more and more advanced, sometimes it is necessary to take a step back and return to the basics. Without a strong foundation, the whole building comes down. This can be widely applied to nearly every profession, sport, science, and everything in between. That being said, what are the basics of coding for patient documentation? If you practice in the US, you would most likely tell me ICD-10. Across the pond, however, they probably would default to the ICF. What’s the difference between the two?

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Topics: 2017 New Evaluation Codes

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