CPT code 97162 refers to a type of physical therapy evaluation that involves moderate complexity. CPT 97162 represents “Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family..”
Procedure Explanation:
This procedure involves a physical therapist assessing a patient’s condition with moderate complexity. It includes looking at the patient’s current health issues along with one or two additional factors that might affect the treatment plan. The therapist will examine various parts of the body to understand problems with movement, activity, or participation in daily life using standard tests. The patient’s condition might change, requiring careful decision-making by the therapist. This evaluation typically takes about 30 minutes with the patient and/or their family. Included in this procedure are assessments of the patient’s current health, specific elements of their body’s functioning, and activity levels. It does not include high complexity evaluations or simpler assessments.
Common Names:
- Moderate Complexity PT Evaluation
- PT Exam – Moderate
- 97162 Evaluation
Relative Value Units (RVU):
The RVUs associated with this code are 1.54.
How This Procedure Appears:
- Operating Room Schedule Name: Moderate PT Evaluation
- Surgical Consent Form Name: Moderate Physical Therapy Evaluation
Typical Patients and Diagnoses:
This type of evaluation is often used for patients who have moderately complex issues. They might be experiencing new injuries, recurring pain, or gradual changes in physical abilities due to conditions like arthritis. For example, someone recovering from a sports injury or a person managing chronic back pain would be typical candidates for this kind of evaluation.
Associated ICD-10 Codes:
- M25.561: Shoulder pain, often used for patients experiencing moderate pain in their shoulder, possibly affecting their ability to move their arm.
- R26.2: Difficulty in walking, which might be used for individuals who are having trouble walking normally, possibly due to balance issues.
- M54.5: Low back pain, typically used for patients suffering from significant discomfort in their lower back area that affects daily activities.
Summary
In summary, code 97162 describes a moderate complexity evaluation by a physical therapist. Typical ICD-10 codes associated with 97162 include M25.561 (Shoulder pain) and R26.2 (Difficulty in walking).
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.