Harmony Healthcare Blog

Decoding the CPT Codes: Physical Therapy and Occupational Therapy Evaluation (Part 1)

Posted by Melissa Fox on Wed, Dec 21, 2016


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


PhysicalTherapy.jpgAs we approach January 1, 2017, therapy providers are preparing for the New CPT Code for Physical Therapy and Occupational Therapy Evaluations. Many therapists are reviewing the recent American Medical Association Common Procedural Terminology for 2017 manual and questioning the comparison of OT versus PT Evaluation codes. However, the development of each CPT codes was not to parallel the reported outcomes between PT and OT, but to reflect specific elements that reflect the discipline specific role of either a PT or an OT.

Decoding OT Evaluation Definition

The New OT evaluation codes that go into effect January 1, 2017 were developed through the collaboration of The American Medical Association (AMA) Common Procedural Terminology (CPT) 2017 manual and with the input of AOTA. 

The precise language in the 2017 CPT Manual, provides the following introduction to the code for OT evaluation:

OT evaluations include an occupational profile, medical and therapy history, relevant assessments, and developing a plan of care, which reflects the therapist’s clinical reasoning and interpretation of the data. Coordination, consideration, and collaboration of care with physicians, other qualified health care professionals, or agencies is provided consistent with the nature of the problem(s) and the needs of the patient, family, and / or other caregivers (pg 644). 

The definition follows the approach to evaluation in the OT Practice Framework: Domain and Process (3rd edition, AOTA 2014).

The AOTA has published the Code Language on Levels and describe exactly what should be done in an evaluation: 

  • Occupational Profile and client history (medical and therapy)
  • Assessment of Occupational Performance
  • Clinical Decision Making
  • Development of plan of care. 

Occupational therapists are encouraged to reflect clinical decision making that supports clinical outcomes which are objective and measurable to indicate low, moderate and high complex resident who required the associated service time of OT evaluation.Free RUG Analysis - Compare your facility's utilization with current national CMS data

Decoding PT Evaluation Definition

The 2017 CPT Manual, provides the following introduction to the code for PT evaluation: 

PT evaluations include patient history and an examination with development of a plan of care…which is based on the composite of the patient’s presentation.” And “Coordination, consultation and collaboration of care with physicians…consistent with the nature of the problem(s) and the needs of the patient, family, and/or other caregivers.” 

The APTA has published the Requirement components as follows: 

  • History
  • Examination of body Systems
  • Clinical Presentation
  • Clinical Decision Making (complexity) 

Each discipline has defined through the AMA and collaboration of ATPA and AOTA the discipline specific CPT code changes. Clinicians can refer to the publications on the APTA and AOTA website for further details of the definition of each requirement component for CPT code use. 

If you have questions about the new CPT Codes, please contact Harmony Healthcare by clicking here or calling our office at (800) 530-4413.

For further details on definition visit AOTA: http://www.aota.org/~/media/Corporate/Files/Advocacy/Federal/Evaluation-Codes-Overview-2016.pdf 

For further details on definition visit APTA: http://www.apta.org/uploadedFiles/APTAorg/Payment/Reform/NewPaymentSystemWebinar_EvalCodesforPhysicalTherapy.pdf 


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Tags: CPT Codes

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