CPT code 97161 refers to a basic assessment completed by a physical therapist to create a simple treatment plan. CPT 97161 represents “Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family..”
Procedure Explanation:
This code represents a straightforward evaluation involving a discussion about the patient’s health without major complications. The therapist checks a couple of aspects of the body using standard tests. The patient’s situation is stable and not too complicated, leading to simple decision-making on what steps to take next. The session usually lasts about 20 minutes and involves direct interaction between the patient and therapist, sometimes including family members. The procedure doesn’t cover detailed examinations or involve complex case handling.
Common Names:
- Low Complexity PT Evaluation
- Basic Physical Therapy Assessment
- PT Eval Level 1
Relative Value Units (RVU):
The RVUs associated with this code are 1.54.
How This Procedure Appears:
- Operating Room Schedule Name: Physical Therapy Eval – Low Complexity
- Surgical Consent Form Name: Physical Therapy Basic Assessment
Typical Patients and Diagnoses:
This procedure is commonly used for patients with straightforward physical complaints or limitations, like someone recovering from a mild injury or dealing with a minor functional issue. For instance, a person with a slight shoulder pain or someone experiencing some difficulty with balance might need this type of evaluation.
Associated ICD-10 Codes:
- M54.5: This code refers to low back pain, a common issue where someone might feel discomfort in their lower back area.
- G57.60: Identifies neuralgia and neuritis, unspecified, which involves nerve pain without a distinct cause.
- M25.551: This code is used for pain in the right hip, a condition where someone feels soreness specifically in their right hip joint.
Summary
In summary, code 97161 describes a straightforward physical therapy evaluation to understand and plan treatment for non-complex conditions. Typical ICD-10 codes associated with 97161 include M54.5 (low back pain) and G57.60 (nerve pain without a known cause).
Disclaimer
This post is for informational purposes only and is not a substitute for medical advice. “CPT” and CPT Codes are registered trademarks of the American Medical Association. HCPCS codes are managed by Medicare and are not subject to copyright.