The “Catch 22” of the New 2017 Eval Codes

Most therapists are submitting the new 2017 eval codes and thinking, “What’s the big deal?  I know how to recognize complexity.”

The Long Answer:  Follow this APTA link to review over 100 pages of instructions on how to comply with 2017 eval code reporting

The Short Answer:  The CMS specifies that the individual factors that impact complexity need to be categorized and scored.  The process for this is outlined below:

After categorizing and scoring, you must document each factor that impacts complexity. Although these topics have already been documented in your eval, the CMS rules require the therapists to document them a second time, defending the eval code selection with 100-200 words. Here’s an example:

The patient’s diagnosis is highly complex. Complexities related to the patient’s history that impact the plan of care include: The patient is 82 years old, which is expected to increase recovery duration. The diagnosis is a relapse of a prior episode in 2001. The patient’s home has stairs. The patient lives alone. The patient does not regularly exercise and demonstrates low muscle tone, strength, and endurance. The patient’s symptoms are aggravated by their daily routine and/or profession. Prior hip joint replacement. Significant communication challenges because English is not the patient’s primary language.  During the examination, the following complexities, which impact the plan of care, were discovered: Unstable gait/balance/mobility, as noted in objective findings. Limited ROM, as noted in objective findings. Limited strength, as noted in objective findings. BMI score of 32.23. The patient’s clinical presentation is high/unpredictable.  Surgery date 8/1/16. The patient is a falls risk.  Evolving pain, fluctuating between 5/10 – 8/10 today vs 6/10 at onset. The patient’s condition is degenerative.  The therapist is unable to eliminate worsening of symptoms or predict timing. Optimal index disability index score: 77.  Therapist decision making is highly complex

Additionally, payors will soon pay more for higher levels of complexity.  CMS warns, if you don’t defend your reported eval code complexity, you are subject to takebacks.

The “Catch 22”

Typing 200 additional words does not help your patient progress. Remember, in 22 months you will be “paid for progression;” however, you are required to spend more time documenting (which lessens available treatment time), while being paid for progression.  But the ONLY thing that improves patient progression is your hands-on treatment time.  Crazy making, isn’t it?

There is a Solution:

Systems4PT’s one-of-a-kind EMR uses a patent-pending process to:

  • Scours your eval for topics that impact complexity
  • Categorize those topics for you
  • Score those topics for you, and
  • Recommend the defensible eval code

The above happens in a nanosecond, and you will then apply your clinical judgement (a 30-second process).

Systems4PT’s patent-pending advanced technology, in another nanosecond and based on your clinical judgement:

  • Adds the defensible eval code, and then
  • Adds the 100 – 200 words of defensive documentation to the evaluation (example below)

The Benefit of Our Solution:

And after spending 30 seconds (and two nanoseconds) on eval codes, the therapist spends their you will spend your time treating instead of typing.  We give you the ability to spend as much hands-on time with your patients, which will drive progression, while you are properly and compliantly reimbursed for the great work you do – without the catch 22.

A Systems4PT evaluation takes half the time of your current EMR and we can prove that.

Systems4PT.  Treat More, Type Less TM