A number of orthopaedic groups have started seeing patients for pre-op PT visits prior to joint replacements and some other surgeries. Some of this trend is related to the BPCI program, but also works when care is delivered on a fee for service basis.
These pre-op visits not only include an initial evaluation (97001) as discussed below, but also instructions in the use of assistive device that will be used post-operatively and instructions in the exercises that are in the post-op protocol. These tasks are much easier to learn when the patient is not dealing with the post-op pain, swelling, etc. There are a number of studies supporting the benefits of these pre-op visits on post-op recovery. (E.g., http://jbjs.org/content/96/19/e165; http://www.ncbi.nlm.nih.gov/pubmed/18499950)
The pre-op PT visit will typically include assessments of function, balance, ROM and strength, and will give the therapist a chance to answer any of the patient’s questions regarding post-op PT and address any other concerns. We also expect that the pre-op visit will help reduce the post-op PT cancellation/no show rate.
For billing purposes, we recommend that the evaluation component of both the pre-op and initial post-op visit be coded using the 97001 initial evaluation code. In addition to the initial evaluation, the one-time pre-op visit will also typically include billing for gait training and therapeutic exercise.
For your codes, the following is a discussion of why you should use the 97001, rather than 97002, for the post-op evaluation.
The 97001-04 codes were added in 1998; however, at that time the only guidance was to contrast these codes to the E&M codes used by physicians. In the September 2001 CPT Assist, the AMA clarified that CPT Code 97001 is for the start of an encounter when the results will be used “in the development of a plan for management of a patient’s problems” as compared to 97002 which is used throughout the encounter when performing “subsequent assessments of the injury/disability to determine the progress/success of the treatment(s) given.” The AMA further notes that although 97002 is “usually performed during a treatment course;” when “a new problem/abnormality is encountered” during the course of treatment 97001 may be required to “determine what course of action (if any) would best afford rehabilitation of the injured/disabled body area.”
In the case of performance of a pre-op evaluation, the results are not being used to establish a treatment plan. The visit is anticipated to be a one-time only visit. The patient may not return following the joint replacement even though it had been anticipated. And, even when the patient returns there will have been a significant change in medical and functional status to require an initial evaluation.