The evaluation time in a SNF Medicare Part A patient does not count towards the therapy minutes needed. This time can add up depending upon the complexity of the evaluation. Since the new evaluation codes have a time frame associated with them, I was wondering how other SNF’s might be accounting for the evaluation minutes for their SNF Part A patients? Can I bill and be paid for both an evaluation and treatment provided on the same day? When a patient comes in for their fist visit in 2017 for physical therapy and/or occupational therapy, do I need to bill one of the new evaluation codes on that first date of service in 2017? One of my peers listened to your “2017 New Evaluation Codes and Payment Updates” webinar on December 14, 2016 and got the impression that you have to code the new evaluation codes based off of the lowest scoring component of the evaluation (history & co-morbidities, exam elements, clinical presentation & clinical decision making). So, for example, if you had a patient with no co-morbidities that impact the plan of care (low), but had 6 elements in the exam (high), felt their clinical presentation was evolving (moderate), and felt the clinical decision making was moderate, and it took you 45 minutes to do the evaluation, you still have to bill the low evaluation CPT code because there were no co-morbidities. Can you site the CPT literature that supports that you have to bill the CPT eval code that is equal to the lowest graded section? Do we need to set up 2 fee schedules in 2017 – 1 for Medicare and 1 for Commercial plans? CPT has listed “typical times” for each of the PT/OT codes. Do the same “greater than 50% of the visit spent face to face counseling/coordinating care with the patient” rules apply for these codes, as they do for typical E/M codes? CPT states not to follow E/M guidelines for Physical Medicine and Rehab codes, so I am confused as to how “typical time” impacts the level of evaluation that I report. For the new physical therapy evaluation CPT codes, must we use an outcome tool? I am unclear what the American Medical Association means by “standardized tests and measures”. Do most pediatrics patients automatically fall into the low complexity category due to lack of past medical history? How can therapists submit a CPT code for a pre-authorization without knowing the complexity up front? Do you have a source from CMS that explicitly states that you must “code down” when an evaluation doesn’t meet all of the criteria of a higher level of complexity? (Apparently some people have heard conflicting advice on this.) How do I code an evaluation for a patient with workers compensation primary and Medicare secondary? Will providers of inpatient services be required to use the new evaluation CPT codes? In what outpatient settings will the new evaluation and reevaluation CPT codes apply to? Will workers compensation and auto no-fault carriers have to use the new physical and occupational therapy evaluation and reevaluation codes? Are the new physical and occupational therapy evaluation and reevaluation codes only applicable to Medicare patient’s? Will occupational therapists have a new reevaluation code in 2017? Will physical therapists have a new reevaluation code in 2017? Are the new occupational therapy evaluation codes timed or untimed? Are the new physical therapy evaluation codes timed or untimed? What are the new occupational therapy evaluation CPT codes? What are the new physical therapy evaluation CPT codes? Is it true that physical and occupational therapists will have new evaluation CPT codes in 2017?

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