CPT code 97163 refers to a detailed assessment performed by a physical therapist to evaluate a person’s movement and physical capability. CPT 97163 represents “Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family..”
Procedure Explanation:
This code is used for a complex physical therapy evaluation. During this process, a therapist reviews the person’s health condition, focusing on issues that might affect the treatment plan. They conduct tests on different parts of the body, assessing at least four factors such as mobility or physical functions. This evaluation is aimed at patients with complicated or changing health issues. It generally takes about 45 minutes and involves direct interaction with the person and possibly their family. Simple evaluations or those with fewer factors considered are not covered under this code.
Common Names:
- Comprehensive Physical Therapy Evaluation
- PT Evaluation High Complexity
- Advanced Physical Therapy Assessment
Relative Value Units (RVU):
The RVUs associated with this code are 1.54.
How This Procedure Appears:
- Operating Room Schedule Name: High Complexity PT Evaluation
- Surgical Consent Form Name: Consent for Comprehensive PT Assessment
Typical Patients and Diagnoses:
This type of physical therapy evaluation is generally used for individuals who have multiple health issues affecting their physical abilities. For instance, a patient recovering from a stroke with additional conditions like diabetes or arthritis might require this kind of thorough assessment to tailor a suitable therapy plan.
Associated ICD-10 Codes:
- M54.5: This code is used for diagnosing low back pain, a common condition needing physical therapy assessments to determine appropriate treatment methods.
- I69.351: Represents hemiplegia (paralysis on one side of the body) as a result of a stroke, requiring detailed evaluations to address rehabilitation needs.
- M19.90: Used for unspecified osteoarthritis, a condition that affects joints and may require personalized physical therapy strategies.
Summary
In summary, code 97163 describes a detailed process for evaluating a patient’s physical challenges, mainly when multiple factors affect their health. Typical ICD-10 codes associated with 97163 include M54.5 (low back pain) and I69.351 (post-stroke hemiplegia).
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.