What’s New for CPT Eval Codes in 2017

Today is Election Day. I thought it would never come. The interminable Presidential Campaigns we just observed wore me out. After all of the bickering and fighting, I hope that we will move forward and begin to develop a consensus on the way forward.

But, just when I begin to feel a little more hopeful, we run into another well meaning, but horribly administered change, from our friends at CMS. To summarize, there is yet more complexity coming your way, with no apparent benefit.

We have no lack of complex requirements already: Functional Limitation Reporting, Physician’s Quality Reporting System, Comprehensive Coding Initiative Edits, Progress Reports, Plans of Care, Plan of Care Approvals, the “Therapy Cap”, and Manual Medical Review among others. Worse yet, some of these programs, like the Therapy Cap and Functional Limitation Reporting, are requirements focused solely on PT, OT, and Speech. (Can you imagine the howling you would hear if CMS tried to come up with a program like Functional Limitation Reporting for physicians?)

And the next coming attraction? Changes to the CPT (Current Procedural Terminology) evaluation codes for Physical Therapy and Occupational Therapy.

The new 2017 CPT eval codes for PT, OT, and SLP are here. Don't miss this cheatsheet to help familiarize yourself with the new codes.

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Our professional organizations have been working with the AMA and CMS to revise the “one size fits all” evaluation codes. After years of diligent work, they were able to come up with a stratified evaluation code system that takes the complexity of the patient’s condition into account, much like the stratified Evaluation and Management codes used by physicians for years. The codes are well thought out, and take into account factors like comorbidities, body parts affected, and personal factors.

This was a big win, or at least it was for a while until we found that CMS made the puzzling decision to value all of the stratified codes equally. So, we have yet one more requirement that makes no real sense with no apparent benefit.

Why add to the documentation burden without compensating the therapist for the additional documentation required to justify complexity?

Since payment for the Low Complexity Evaluation is the same as the payment for the High Complexity Evaluation, why bother with putting any effort into justifying High Complexity at all?

It seems that they “fixed” the least of our problems. Why in the world were these stratified evaluation codes finally approved without also fixing the horribly complicated mess caused by the 15 minute “timed” procedure codes?

Dwelling on those questions too much will not gain us much. We have to figure out how to navigate this latest challenge together. We will work with our clients to explain the new CPT codes as simply as possible and help you with the new documentation requirements for supporting evaluation complexity. I recently hosted a webinar reviewing the changes, don’t miss its on-demand recording so you can understand the coming changes and how they will impact you. Sign up to watch it here.

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