How to Avoid or Prevail on a Physical Therapy Audit

PhysicalTherapy Re-evaluations:   CPT code 97002

Physical therapists should be careful when using the 97002 code.  The office of Inspector General is starting nationwide investigations for those using this code frequently.  The Medicare requirements on when to bill for re-evaluation 97002, Medicare Benefit Policy Manual Chapter 15 Section 220, says a Re-evaluation is providing additional objective information not included in other documentation.  Re-evaluation is separately payable and is PERIODICALLY ADDED and indicated during an episode of care when the professional assessment of a clinician indicates a significant improvement, or decline, or change in the patient's condition or functional status that was not anticipated in the plan of care......Routine weekly assessments of expected progression in accordance with the plan are not payable as re-evaluations.

Assessment for Jimmo purposes, 97002 usage

 "Assessment determines changes in the patient's status since the last visit/treatment day andwhether the planned procedure or service should be modified.  Based on the assessment data the professional may make judgments about progress towards goals and or determine that a more complete evaluation or re-evaluation is indicated.  Routine weekly assessments of expected progression in accordance with the plan are not payable as re-evaluations."  Same citation as above, the Medicare Benefits Policy Manual, chapter 15, section 220.