Wow! It’s already 2017 and as our gift from the American Medical Association, we have new CPT evaluation codes to try to figure out while still recovering from the holidays.
So to ring in the new year, I decided write a post to help crack the new codes.
I compiled as many resources as I could, some from AOTA, some from my hospital, and some from other internet sources that I’ll provide links to at the end of the post.
The explanations in this post are intended to be condensed summaries of each new code. For the full versions, refer to the resources linked at the bottom of the post.
Keep in mind that the old eval and re-eval codes are being eliminated.
Download the Printable PDF Chart Here
Summary of New 2017 Occupational Therapy Codes
97165 – Occupational Therapy Evaluation, Low Complexity
- Includes a brief chart review relating to the patient’s present problem
- Your assessment identifies 1-3 performance deficits that affect ADL performance
- Low complexity of clinical decision making during evaluation; includes analysis of occupational profile, problem-focused assessment data analysis, limited treatments considered
- The patient has no comorbidities that affect occupational performance
- You (the OT) do not have to modify tasks or provide assistance (physical or verbal) to complete the evaluation
- The evaluation takes approximately 30 minutes of total face to face time with the patient and/or family members (this is only a guideline and not set in stone)
97166 – Occupational Therapy Evaluation, Moderate Complexity
- The chart review is expanded; this includes reviewing the patient’s medical records as well as reviewing physical, cognitive, or psychosocial history
- Your assessment identifies 3-5 performance deficits that affect ADL performance
- Moderate complexity of clinical decision making; includes analysis of occupational profile, detailed assessment data analysis, several treatments considered
- Minimal to moderate task modifications or assistance with assessments during evaluation are necessary to help the patient complete the eval
- The evaluation takes approximately 45 minutes of total face to face time with the patient/family
97167 – Occupational Therapy Evaluation, High Complexity
- An extensive chart/medical history review as well as extensive additional review of physical, cognitive, or psychosocial history related to current functional performance
- Your assessment identifies 5 or more performance deficits that affect ADL performance
- You have a high complexity of clinical decision making during the evaluation process; includes analysis of occupational profile, comprehensive assessment data analysis, multiple treatments considered
- The patient has multiple comorbidities that affect their occupational performance
- You are providing significant, or maximal, modification of tasks or assistance with the eval assessment for the patient to complete the evaluation
- The evaluation takes you approximately 60 minutes of total face to face time
97168 – Occupational Therapy Re-Evaluation
The Re-evaluation thankfully does not have different levels like the Evaluation, but is a different code than before so I still wanted to include it. The main information provided about re-evaluations is the following:
- It is a revised plan of care
- It is an update to the initial occupational profile that reflects changes in the patient’s condition that affect intervention or goals
- It is performed when there is a documented change in functional status or a significant change to plan of care
- Typically includes 30 minutes of face to face time
And for easy reference on the job:
Download the Printable PDF Chart Here
I also want to note that these codes are applicable to all patients, not just patients using Medicare.
I know it’s hard right now, but I promise it’ll get easier. What has helped me tremendously in the acute care and inpatient rehab settings is to go over both the OT and the PT checklists with the physical therapist that is also evaluating my patient.
You may find some discrepancies as the PT codes criteria is a little different, but it’s still going to be helpful to have another therapist to brainstorm with.
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I hope this post has helped you with figuring out the new 2017 Occupational Therapy Evaluation Codes. If you still feel stuck, check out the resources below. I also added the Physical Therapy changes because to me they make more sense than the OT code changes.
I would also love to know if you have any tips that have helped you figure out this process. Please share in the comments below!
Additional Resources
Why Are There New Evaluation CPT Codes? Answers to Your Coding Questions (AOTA)
New Evaluation Codes for OT in Medicare Physician Fee Schedule (AOTA)
Quick Guide to the 3 Levels of Physical Therapy Evaluation (APTA) These are the new Physical Therapy codes, so they are different codes and criteria than ours, but the chart on Page 2 made more sense to me than AOTA’s criteria.
