New OT Evaluation Codes: Counting Performance Deficits
Last week, I wrote an article “New Evaluation Codes: What is an Element” where I took a patient with a rotator cuff repair being evaluated by a physical therapist and showed you how to count elements based on your evaluation findings. This week, I want to take that same patient and have her evaluated by an occupational therapist and show you how to count performance deficits.
Occupational therapy evaluations include the following components:
- Occupational profile and client history
- Assessments of occupational performance
- Clinical decision making
- Development of plan of care
Lets now define the examination component for the 3 occupational therapy evaluation codes.
97165 – Occupational therapy evaluation: low complexity: An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions
97166 – Occupational therapy evaluation: moderate complexity: An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions
97167 – Occupational therapy evaluation: high complexity: An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions
To illustrate what is a performance deficit and how to count performance deficits, I will use a 35 year-old right hand dominant female who tore her right rotator cuff 6 weeks when she stumbled going down the stairs and grabbed the handrail to stop herself from falling. Patient had the tear surgically repaired and is now presenting for her occupational therapy evaluation. Patient resides at home with her husband and 7 month-old daughter. Her husband is gone from the house Monday – Friday from 7:00AM until 5:30pm. The evaluation includes the subjective intake, objective examination using standardized tests and measures as well as the completion of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire.
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This is very helpful. Thank you!
Thank you for the feedback.
With the new codes is it still appropriate to charge treatment with evaluations? For example if a therapist was with the patient for 60 minutes performed a high eval and charged an exercise or activity along with the eval charge.
Please refer to the most current version of CCI edits.
Have a question if anyone has encountered this issue: had a CCI edit error due to the fact that PT charged Moderate complexity eval 97162 and OT charged low complexity eval 97165 on the same date of service. In reviewing it is clear that there is not an CCI edit to correct this issue. Suggestions to correct? The treating therapists feel that is a correct selection of complexity levels.
I wrote an article on this on January 16, 2017.