Therapeutic exercise is one of the most common interventions provided by physical therapists and occupational therapists. Considered a skilled intervention when performed by a qualified therapist, it can involve any type of equipment or device that allows for repetitive motion, range of motion (ROM), strength training, or other exercises that promote movement in a patient’s joints and tissues. Therapeutic exercise may be used as part of preoperative evaluation before surgery, postoperative rehabilitation following surgery, or following injury from an accident or stroke. In this article, the CPT code 97162 for physical therapy evaluation of moderate complexity is examined in detail.
What is CPT Code 97162?
CPT code 97162 is used for physical therapy evaluation of moderate complexity before the appropriate therapeutic exercises and treatment options are recommended. A physical therapist will conduct a physical therapy evaluation that includes history, to rule out any adverse factors. The PT observes whether the patient’s condition is changing and assesses a minimum of three elements relating to body structure and function, limitations such as joint flexibility, muscle strength—and gait.
Billing using CPT code 97162 is done when the PT, using standardized tests, measures various aspects of the patient’s condition and performs clinical decision–making of moderate complexity for 30 minutes or more, involving one-to-one face time with the patient and/or family.
What is Physical Therapy Evaluation?
Many patients who require physical therapy have suffered an injury or developed a disorder that causes pain and limits their ability to function. Physical therapists assess and treat physical problems to help their patients improve their function and thereby quality of life.
After the initial evaluation, the physical therapist performs a physical assessment to measure how severe the patient’s problem is and where it is localized. The assessment could cover the following
- Range of Mobility (ROM) test
- Test of functional mobility
- Strength and balance tests
- Assessment of palpitations
During a physical examination, the therapist provides directions and coaching to the patient through each movement. Finally, the Therapist formulates and discusses a treatment plan with the patient and recommends ways to achieve the patient’s goals. The PT can start the treatment right away, using modalities like electrical stimulation and can also prescribe at-home exercises to manage pain and improve function.
The two familiar CPT codes for PT evaluation and re-evaluation
Until 2017, 97001 and 97002 were the familiar and accepted codes for PT evaluation and re-evaluation respectively.
97001 : Physical Therapy Evaluation
CPT 97001 was used for physical therapy evaluation of 30 minutes. The patient’s joint flexibility, gait, muscle strength and neuromuscular function were evaluated throughout the session. Physical therapists generally began the 97001 CPT code procedure with a general evaluation of the patient followed by a brief medical history.
The physical therapist then performed a series of tests to assess the patient’s mobility, gross neuromuscular status, coordination and balance, flexibility and muscle strength. The entire procedure occupied a span of 30 minutes on average. Finally, the various clinical findings were input as a special section of the SOAP note sheet for evaluation. After the evaluation, possible physical therapy interventions and an overall diagnosis were discussed with the patient.
97002 : Physical Therapy Re-evaluation
Physical therapy reevaluation of 60 minutes performed by a physical therapist was billed using the CPT code 97002. The reevaluation only occurred if the documentation of a patient’s condition or diagnosis proved that a significant change has occurred in the patient’s condition. The physical therapist may have to modify the patient’s treatment plan and goals, and then reevaluate the progress. The reevaluation included all of the components described by CPT code 97001 in the initial evaluation.
The process included a comprehensive assessment of the patient by the PT including medical history review and evaluation of various physical and functional factors. The reevaluation lasted for an average span of 60 minutes. The Assessment and Planning section of the SOAP note was updated with the findings and possible physical therapy interventions were discussed with the patient.
Why were the original CPT codes 97001 and 97002 changed?
The familiar PT evaluation codes were deleted in 2017 and a new set of codes incorporating the evaluation complexity of the patient’s condition were introduced. The changes are compactly described in the following table.
|Original CPT Code||New CPT Codes|
|97001 Evaluation||97161 Low Complexity Evaluation
97162 Moderate Complexity Evaluation
97163 High Complexity Evaluation
|97002 Re-evaluation||97164 Re-evaluation|
What is the difference between CPT codes 97161, 97162, and 97163?
Diving a bit deeper, let us examine the table below encapsulating the new Physical Therapy Evaluation CPT code group 97161 – 4
|Code/ Complexity||Patient History||Body Examination Elements||Clinical Presentation||Decision Making Complexity||Min time spent 1-1 with patient|
|97161: Low complexity||Free of any personal factors and/or comorbidities that would interfere with the plan for care.||1-2 elements from any of the following: body structures and functions, activity limitations, or participation restrictions||Stable and uncomplicated||Low complexity and can be performed using standardized patient assessment instruments or by a measurable assessment of functional ability.||20 minutes|
|97162: Moderate complexity||History presents a problem with 1-2 personal factors and/or comorbidities that impact the plan of care||3 or more elements from any of the following: body structures and functions, activity limitations, or participation restrictions||Evolving with changing characteristics||Moderate complexity when performed using standardized patient assessment instruments or by a measurable assessment of functional ability.||30 minutes|
|97163: High complexity||History presents a problem with 3 or more personal factors and/or comorbidities that impact the plan of care||4 or more elements from any of the following: body structures and functions, activity limitations, or participation restrictions||Unstable with unpredictable characteristics||High complexity when performed using standardized patient assessment instruments or by a measurable assessment of functional ability.||45 minutes|
97164: Re-evaluation of physical therapy established plan of care
This code is used when an examination including a review of history and use of standardized tests and measures is required. The plan of care is revised using a standardized patient assessment instrument or a measurable assessment of functional ability.
The physician spends about 20 minutes face-to-face with the patient and/or family.
It becomes clear from the above that apart from the complexity of the evaluation, the length of the average time spent by the therapist one-to-one with the patient and/or family becomes an important but not a determining factor in billing for the relevant CPT code. Further, it is important to understand the key components of documentation for claiming reimbursement using these CPT codes.
What Documentation is Required for this CPT code group ?
The American Physical Therapy Association (APTA) recommends that physical therapists use these codes when appropriate, and document them carefully to ensure reimbursement. Although there are no strict guidelines for what should be included in the documentation, physical therapists should include:
- Document each required part of the reported code.
- Even if one component of a system is not able to be supported, report low level complexity.
- Ensure that the report clearly communicates not only your interpretation of the patient’s problems, but also how other health professionals might view these issues if presented with this documentation.
To ensure accurate physical therapy medical billing and coding, the therapist is required to follow the APTA’s guidelines on required components—such as diagnoses and treatment plans—and include supporting documentation whenever possible.
- Patient’s personal factors and comorbidities: The documentation should clearly state the personal factors that affect each individual patient’s participation in and ability to progress through their plan of care. To indicate the level of complexity, identify all relevant personal factors and/or comorbidities. Besides retaining a past medical history checklist, identifying comorbidities and/or personal factors in the evaluation report, it is necessary to specify how these elements will affect treatment.
- Impacted body systems: The documentation should clearly list all body structures and functions that will be addressed by the physical therapist during treatment, as well as any activity limitations/participation restrictions that may result. It is necessary to state the combined number of these structures and functions, together with their level of complexity. The examination results must be quantified using standardized tests and measures.
- Clinical presentation: The assessment portion of the report should include evidence of the patient’s clinical presentation. Other elements of the documentation could include vital sign response, description of levels of pain and cognitive performance.
- Clinical decision-making: Thorough documentation of evaluation findings demonstrating clinical decision-making, including the number and types of components considered in addition to those used as support for specific decisions.
- Functional outcome tools and results: The documentation should include the results of any standardized patient assessment and functional outcomes tests used by the physical therapist for clinical decision making.
- Complexity level: The level of complexity – low, medium or high should be documented in the evaluation report and also supported throughout.
Kemtai: A game changer for physical therapists
As at-home physical exercises form an important part of most patients’ treatment plans, the use of AI-based exercise platforms as effective tools for PTs is on the rise. For example, using Kemtai’s motion tracking platform, therapists are enabled to analyze patient movements to make informed decisions about the most effective treatment plan. Physical therapists can prescribe exercises for patients and monitor their progress from a distance using video feedback. The physical therapist is able to make adjustments in real time, resulting in more efficient appointments for both patient and doctor.
Kemtai’s Motion Tracking technology allows patients to benefit from a powerful and user-friendly platform that does not require any heavy or specialized equipment. They can control their money, time, and privacy by using their own smartphones to perform the exercises at home alone.
For therapists, kemtai’s motion tracking platform is a game changer. It gives them detailed views of their patients’ progress over time so they can plan future sessions more effectively as well as adjust in real-time or between visits if necessary. This technology can be used to track patients’ progress, provide feedback and guidance on home exercise programs, keep people motivated—and engaged in their own treatment.