CPT® Code 97003 | Case2Code

Code deleted. See 97161-97172.

Official Description

Occupational therapy evaluation

Common Language Description

An occupational therapy evaluation, identified by CPT® Code 97003, is a comprehensive assessment conducted by an occupational therapist to determine a patient's ability to perform daily activities and to identify any impairments that may hinder their independence. This evaluation is crucial for developing a tailored treatment plan aimed at enhancing the patient's overall health and personal well-being. During the initial evaluation, the occupational therapist gathers a detailed patient history, which serves as a foundation for understanding the individual's specific needs and challenges. The assessment encompasses a thorough evaluation of the patient's physical, mental, and neurobehavioral status, focusing on identifying functional limitations that affect their ability to engage in activities of daily living (ADLs). The occupational therapist examines various aspects of physical functioning, including any musculoskeletal conditions that may impact the patient's ability to perform tasks. Additionally, cognitive and psychosocial factors are assessed to understand how they influence the patient's capacity to carry out ADLs. The evaluation includes assessing basic activities such as dressing, bathing, and mobility, as well as more complex tasks necessary for independent living, like shopping, cooking, and utilizing transportation options. Furthermore, the occupational therapist identifies potential barriers within the patient's home, school, work, and community environments that may impede their functioning. This comprehensive evaluation also includes an assessment of the need for adaptive equipment to facilitate the patient's independence. Following the evaluation, the occupational therapist provides a written report and formulates an occupational therapy treatment plan tailored to the patient's specific needs. In cases of re-evaluation, the therapist takes an interim history, assesses the patient's response to previous treatments, and adjusts the plan of care accordingly to ensure optimal outcomes.

1. Indications

The occupational therapy evaluation (CPT® Code 97003) is indicated for patients who require assessment of their ability to perform daily activities due to various impairments. The following conditions may warrant an occupational therapy evaluation:

Physical Impairments Patients with musculoskeletal conditions that affect mobility and functional capabilities.
Mental Impairments Individuals experiencing cognitive deficits that hinder their ability to perform daily tasks.
Neurobehavioral Impairments Patients with conditions that impact their behavior and cognitive functioning, affecting their daily living activities.
Functional Limitations Individuals who have difficulty with activities of daily living, such as dressing, bathing, and cooking.
Need for Adaptive Equipment Patients who may benefit from assistive devices to enhance their independence.

2. Procedure

The procedure for conducting an occupational therapy evaluation involves several key steps that ensure a comprehensive assessment of the patient's needs and capabilities.

Step 1: Patient History The occupational therapist begins the evaluation by taking a detailed patient history. This includes gathering information about the patient's medical background, current health status, and any previous treatments or therapies that have been undertaken. Understanding the patient's history is essential for tailoring the evaluation to their specific circumstances.
Step 2: Evaluation of Physical Functioning The therapist conducts a thorough assessment of the patient's physical functioning. This includes evaluating any musculoskeletal conditions that may impair the patient's ability to perform daily activities. The therapist may use various tests and measures to assess strength, range of motion, and overall physical capabilities.
Step 3: Assessment of Cognitive and Psychosocial Factors The occupational therapist evaluates cognitive and psychosocial factors that may affect the patient's ability to engage in activities of daily living. This assessment helps to identify any barriers related to mental health or cognitive functioning that could impact the patient's independence.
Step 4: Evaluation of Activities of Daily Living The therapist assesses the patient's ability to perform basic activities of daily living, such as dressing, bathing, and mobility. Additionally, the evaluation includes more complex tasks necessary for independent living, such as shopping, cooking, and transportation access.
Step 5: Identification of Barriers The occupational therapist identifies barriers within the patient's home, school, work, and community environments that may hinder their ability to function independently. This step is crucial for developing strategies to overcome these obstacles.
Step 6: Assessment of Adaptive Equipment Needs The therapist evaluates the need for adaptive equipment that may assist the patient in performing daily activities more effectively. This assessment ensures that the patient has access to the necessary tools to enhance their independence.
Step 7: Documentation and Treatment Plan Development After completing the evaluation, the occupational therapist provides a written report summarizing the findings and develops an occupational therapy treatment plan tailored to the patient's specific needs and goals.

3. Post-Procedure

Following the occupational therapy evaluation, the patient may receive a written report detailing the findings and recommendations. The occupational therapist will develop a treatment plan that outlines the goals and interventions necessary to address the identified needs. In cases where a re-evaluation is conducted, the therapist will take an interim history to assess the patient's response to previous treatments and make necessary adjustments to the plan of care. The patient may be advised on follow-up appointments and ongoing therapy sessions to ensure continued progress towards achieving their functional goals.

Short Descr	OT EVALUATION
Medium Descr	OCCUPATIONAL THERAPY EVALUATION
Long Descr	Occupational therapy evaluation
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	7 - Physical Therapy Service, for which Payment may not be Made
Multiple Procedures (51)	5 - Subject to 20%/25% reduction of the practice expense component...
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	9 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	M5D - Specialist - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	212 - Diagnostic physical therapy