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Occupational, Physical, Speech Therapy

CPT 97167 for OT Evaluation High Complexity

CPT 97167 is a billing code used by occupational therapists to document and report an advanced occupational therapy evaluation with High Complexity. This evaluation is conducted when the patient presents with a complex medical history or multiple co-morbidities that impact their ability to perform daily activities. The evaluation may involve an in-depth assessment of physical, cognitive, and psychosocial factors that influence the patient’s occupational performance.

Examples of when an occupational therapist might use CPT 97167 are:

  1. A patient with a traumatic brain injury (TBI): In this case, an advanced evaluation would be appropriate due to the complexity of the injury and its potential impact on the patient’s cognitive, physical, and emotional functioning. The occupational therapist would assess the patient’s motor skills, cognitive abilities, emotional regulation, and how these factors impact their daily living skills, such as dressing, eating, and hygiene.
  2. A patient with multiple sclerosis (MS): MS is a complex neurological condition that can affect various aspects of a person’s functioning. The occupational therapist would conduct an advanced evaluation to understand the patient’s unique needs and challenges related to their physical, cognitive, and emotional well-being. This assessment may include evaluating the patient’s strength, coordination, fatigue levels, and cognitive abilities, as well as their ability to participate in meaningful daily activities.
  3. A patient with a spinal cord injury (SCI) and associated complications: A patient with an SCI often presents with multiple co-morbidities, such as pressure sores, respiratory issues, and bowel and bladder dysfunction, in addition to their primary mobility limitations. An advanced evaluation would be necessary for the occupational therapist to comprehensively assess the patient’s needs, addressing both their physical and psychosocial functioning. This evaluation may include assessing the patient’s upper extremity strength and function, self-care abilities, and strategies to manage their secondary complications effectively.