New Evaluation Codes for 2017
Tuesday, October 25, 2016
Posted by: Marie Ball
1. 97001 and 97002 will be listed as “deleted” from CPT Register
2. Effective 1/1/2017 97001 and 97002 will be replaced with:
· 97161 Low Complexity Evaluation
· 97162 Medium Complexity Evaluation
· 97163 High Complexity Evaluation
· 97164 Re-Evaluation
3. Each Evaluation code level is comprised of and decided upon by 4 components:
· Clinic Presentation
· Clinical Decision Making
4. Component #1
History- Comorbidities that can impact function and ability in relation to progression of the plan or care; Previous functional levels at the time of evaluation; Previous treatment or other factors that can impact ability to progress and reach goals; social history, home status, work status, cultural indicators and medications. Other Personal Factors: Age, sex, education, profession, social background, experiences; behavior patterns; other factors as to how the patient see’s their injury/impairment.
5. Component #2
Examination- Body structures and Functions: looking at impairments that result in limiting function that are resulting in the presenting condition; regions (head, neck, extremities); systems (musculoskeletal, cardiovascular, neuromuscular). Activity Limitations: self care, preparing food, other ADL’s. Participation restrictions: home life, social activities, work/school/community.
6. Component #3
Clinical Presentation- Stable and Uncomplicated; Evolving with changing characteristics; Unstable with unpredictable characteristics.
7. Component #4
Clinical Decision Making- Clinical judgment is used to determine overall severity of the complaints/conditions; appropriate decisions are made for treatment; is supported by best current evidence.
8. Time is to be used for “guidance only”. Time is not a factor in relation to billing of the code and the decision on which code to bill should not be selected based on time spent on the evaluation.