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New Evaluation Codes for 2017

Tuesday, October 25, 2016   (0 Comments)
Posted by: Marie Ball
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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:

·         History

·         Examination

·         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.

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