As an occupational therapist, getting paid for your services depends on the accuracy of your billing. One key element in ensuring timely and full reimbursement is the 97165 CPT code. This code, used for low-complexity evaluations, plays a crucial role in getting you paid for the work you do. If you want to streamline your billing process and avoid unnecessary delays, this guide will help you understand how to use the 97165 CPT code correctly.
Ready to make sure you’re getting paid right? Let’s dive in.
What is the 97165 CPT Code?
The 97165 CPT code is used for a low-complexity occupational therapy evaluation. It’s the code to use when you’re conducting a straightforward assessment of a patient’s functional abilities, which includes a review of their medical and therapy history. The evaluation typically lasts between 30 to 45 minutes.
This code focuses on situations where the clinical decision-making is not complicated. You’re essentially reviewing a patient’s situation quickly to make a plan for their care.
When to Use the 97165 CPT Code?
The 97165 CPT code is ideal for patients whose condition is straightforward. Here’s when to use it:
- Low complexity cases: When the patient’s issues don’t require a deep dive into their medical history or therapy needs.
- Quick assessment: If you’re able to determine a treatment plan after a brief review of the patient’s situation.
- Minimal performance issues: When the patient’s functional deficits are not extensive, and the need for therapy is clear.
This code is great for simple cases where the therapist can create a plan of care based on a relatively quick review of the patient’s condition.
Why Good Documentation is Key
Proper documentation is a must when using the 97165 CPT code. Here’s why:
- Occupational profile: You’ll need to outline the patient’s abilities, challenges, and therapy goals. This helps tailor the treatment to the patient’s needs.
- Medical and therapy history: A brief overview of the patient’s relevant health and therapy background. This tells the payer why therapy is needed.
- Problem-focused assessment: This is a straightforward evaluation of the patient’s functional abilities, keeping the focus on their immediate therapy needs.
How the 97165 CPT Code Impacts Your Reimbursement
The 97165 CPT code can directly influence how quickly and fully you get reimbursed. When used properly, it ensures that:
- You get paid faster: Accurate use of this code helps prevent unnecessary delays in processing your claims.
- Claim denials are reduced: Proper documentation and correct code usage can help prevent rejections by insurance companies.
- You stay compliant: By following coding guidelines, you keep your practice in line with insurance requirements, minimizing risk.
Common Pitfalls to Avoid with the 97165 CPT Code
Even though the 97165 CPT code is straightforward, there are a few mistakes to watch out for:
- Using the wrong code: If the case is more complex, you might need a different code, like 97166 for moderate complexity or 97167 for high complexity. Make sure the patient’s case matches the low complexity level that 97165 covers.
- Incomplete documentation: If your documentation is lacking important details, it can delay the reimbursement process or lead to claim denials.
- Not being specific enough: If you don’t clearly document the patient’s condition, insurance companies might have trouble understanding the need for therapy, which can lead to confusion or denials.
Best Practices for Billing the 97165 CPT Code
Here are some tips to ensure you’re billing the 97165 CPT code correctly:
- Thorough documentation: Always provide a detailed occupational profile, medical history, and problem-focused assessment.
- Understand payer guidelines: Insurance companies may have specific rules about how they want documentation for low-complexity evaluations. Make sure you know what’s required.
- Use the right code: Only use 97165 for low-complexity evaluations. If the patient’s case is more complex, you’ll need to use a different code (like 97166 or 97167).
- Audit your billing: Regularly review your claims and documentation to make sure everything is accurate. This will help you catch potential issues before they become a problem.
By following these best practices, you’ll increase the chances that your claims get approved and that you’re reimbursed promptly and correctly.
Why Work with Holistic Billing Services?
At Holistic Billing Services, we understand the complexities of billing for occupational therapy. By partnering with us, you can ensure that the 97165 CPT code is used correctly and your billing processes run smoothly. Here’s how we can help:
- Expert billing services: Our team specializes in accurate coding and documentation, including the 97165 CPT code, ensuring that your practice gets reimbursed efficiently.
- Streamlined processes: We use advanced systems to minimize billing errors, reduce denials, and ensure compliance with payer requirements.
- Personalized support: We work closely with you to provide billing solutions that are tailored to your practice’s needs.
Ready to take your billing to the next level? Contact us today, and let’s optimize your revenue cycle by ensuring your use of the 97165 CPT code is on point. Get in touch with us now!
