Are You Ready for OT & PT Code Changes on January 1st, 2017?

Shocking I know, things are changing once again. Didn’t we just go through this with ICD-10? I thought we could at least hold off for a few years before making more changes. There is good news and bad news with this change so I’ll start with the bad news.

Bad News:

You will have to learn new CPT codes for OT and PT Evaluations and Re-Evaluations. 97001, 97002, 97003, and 97004 are going away on January 1st, 2017. They will be replaced with eight (8) new codes with varying levels of complexity in terms of documentation. Not only will you be required to change the way you code procedures but you’ll also be required to support each type of evaluation with detailed documentation. Based on how you do things today it may not be more work, perhaps just a different process. The really bad news is that you still won’t get paid more for doing more complex cases.

For example, the new CPT Code 97163 will be used for a High Complexity Physical Therapy Evaluation. A high complexity evaluation will require you to document 3 or more Personal Factors and Comorbidities that impact the patient, 4 or more body or activity limitations, any patient stability factors, unpredictable or erratic clinical presentation such as biting or kicking fits, and would roughly take 45 minutes to complete.  

You probably all have patients that require more time and effort and you’ve no doubt noticed you get paid the same amount for evaluations regardless of the complexity.

Good News:

The “Plan” is to pay you more for more complex cases in the future. 2017 and perhaps longer will be a time for data collection. The American Medical Association and Centers for Medicare & Medicaid Services will take this time to monitor the use of each code to determine future funding allotments and new values to place on each procedure code. 

This code change (while it may not seem like it right now) will hopefully benefit you in the long run. Yes we have to go through the pain of changing our coding procedures and documentation today but sometime in the not-to-distant future we may see an increase in value for more complex evaluations. The current Florida Medicaid rate of $51.05 is really far too low for the amount of work that goes into a full evaluation, especially for some of our more complex patients. Who know, maybe they’ll surprise everyone and change the rates during 2017! One can only hope.

So now that you’re aware of changes to come, are you ready for them? Do your staff PTs and OTs know about them? If not, I’m happy to help get you ready so that you don’t miss a penny come January 1st, 2017.