Physical Therapy Compliance and Code: What You Need To Know About the Changes
Colorado physical therapists take note. There are new evaluation codes and compliance you need to note. As we strive to continue to provide the best services to our patients, we need to ensure that all the documentation they have is accurate. This allows doctors to determine if the patient is healing at appropriate intervals, and to show justification to insurance companies to continue to allow the patient to attend therapy sessions. It also reduces the risk of red flags coming up, should there be questions about what is taking place in a facility.
Since the start of this year, the American Medical Association has altered their Current Procedural Terminology Codes. The biggest change is to codes 97001 which is currently used to help with reporting evaluations and 97002 which is used to reevaluate services for payment. Those codes are now removed. There are three new codes that are being used as evaluation descriptors. The new codes are 97161, 97162, and 97163.
These codes deal with the complexity of the therapy and the situation at hand. Each is important to understand as how it will relate to us in physical therapy.
97161 is designed for low complexity issues. These are individuals who have had no personal factors or any comorbids that are impacting their care plan as prescribed. This patient has been examined and the appropriate testing and measurements have been done. Providing the functional outcome for different body structures and addressing restrictions are a part of this. For this code, a clinical presentation is required.
97162 is designated for medium complexity issues. This is when there are at least one but no more than two personal factors that have a direct impact on the care of the patient. For this, there must be a functional outcome that touches on at least three unique requirements. An evolving presentation coupled with the changing characteristics of the patient are required for this.
A high complexity situation is what 97163 is used for. This is when there are three or more problems that must be dealt with. At least four requirements must be met with this level must be met, and the presentation must show that the patient has unstable and unpredictable characteristics that must be dealt with.
While exploring the needs of patients, 97164 may also need to be used at some point. This is the new code for reevaluation. This is when you are reviewing the history of the tests and determines the new measurements. For this you must have a newly revised plan that deals with a standardized patient assessment to show what the functional outcome will be.
As we begin to utilize these codes more, there is additional clarification coming. All of which will ensure that the documentation is prepared for approval. Beyond these four changes, the key initial codes are remaining relatively the same. That means billing won’t become harder for our physical therapy offices here in Colorado.
