How To Use CPT Code 97169

CPT 97169 describes the evaluation of an athletic training session of low complexity, which includes a medical history, examination of the affected body area, and clinical decision-making using standardized patient assessment instruments. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97169?

CPT 97169 can be used to describe the evaluation of an athletic training session of low complexity. This code is used when a healthcare provider spends 15 minutes face-to-face with a patient or their family, assessing their athletic injury and making clinical decisions using standardized patient assessment instruments and/or functional outcome measurement tools.

2. Official Description

The official description of CPT code 97169 is: ‘Athletic training evaluation, low complexity, requiring a medical history and physical activity profile with no comorbidities that affect physical activity; an examination of the affected body area and other symptomatic or related systems addressing 1-2 elements from any of the following: body structures, physical activity, and/or participation deficiencies; and clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 15 minutes are spent face-to-face with the patient and/or family.’

3. Procedure

1. The healthcare provider begins by taking a detailed medical history and physical activity profile of the patient, ensuring there are no comorbidities that affect physical activity.
2. Next, the provider performs an examination of the affected body area and other symptomatic or related systems, addressing 1-2 elements related to body structures, physical activity, and/or participation deficiencies.
3. Using standardized patient assessment instruments and/or measurable assessment of functional outcome, the provider makes clinical decisions of low complexity.
4. The evaluation typically takes 15 minutes of face-to-face time with the patient and/or their family.

4. Qualifying circumstances

Patients eligible to receive CPT 97169 services are those who have suffered a sports-related injury and require evaluation by an athletic trainer. The evaluation should be of low complexity, meaning there are no comorbidities that affect physical activity. The provider must assess the affected body area and other symptomatic or related systems, addressing 1-2 elements related to body structures, physical activity, and/or participation deficiencies. The evaluation should involve clinical decision-making using standardized patient assessment instruments and/or measurable assessment of functional outcome.

5. When to use CPT code 97169

CPT code 97169 should be used when a healthcare provider performs an evaluation of an athletic training session of low complexity. This code is appropriate when the evaluation requires a medical history and physical activity profile, examination of the affected body area, and clinical decision-making using standardized patient assessment instruments and/or measurable assessment of functional outcome. The evaluation should typically take 15 minutes of face-to-face time with the patient and/or their family.

6. Documentation requirements

To support a claim for CPT 97169, the healthcare provider must document the following information:

• Medical history and physical activity profile of the patient
• Examination findings of the affected body area and other symptomatic or related systems
• Clinical decision-making process using standardized patient assessment instruments and/or measurable assessment of functional outcome
• Date, start and end time of the 15-minute face-to-face session
• Any additional treatment or referrals recommended
• Signature of the healthcare provider performing the evaluation

7. Billing guidelines

When billing for CPT 97169, ensure that the evaluation is of low complexity and involves a medical history, examination of the affected body area, and clinical decision-making using standardized patient assessment instruments and/or measurable assessment of functional outcome. It is important to spend 15 minutes of face-to-face time with the patient and/or their family. Do not report CPT 97169 if the evaluation is of moderate or high complexity. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 97169 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. An athletic trainer evaluates a high school basketball player who twisted their ankle during a game. The evaluation includes a medical history, examination of the ankle, and clinical decision-making using standardized patient assessment instruments. The session lasts for 15 minutes.
2. A college football player seeks an evaluation from an athletic trainer for a shoulder injury. The evaluation involves a medical history, examination of the shoulder, and clinical decision-making using measurable assessment of functional outcome. The session lasts for 15 minutes.
3. A gymnast visits an athletic trainer for an evaluation of wrist pain. The evaluation includes a medical history, examination of the wrist, and clinical decision-making using standardized patient assessment instruments. The session lasts for 15 minutes.
4. A soccer player consults an athletic trainer for an evaluation of knee pain. The evaluation involves a medical history, examination of the knee, and clinical decision-making using measurable assessment of functional outcome. The session lasts for 15 minutes.
5. A track and field athlete seeks an evaluation from an athletic trainer for a hamstring strain. The evaluation includes a medical history, examination of the hamstring, and clinical decision-making using standardized patient assessment instruments. The session lasts for 15 minutes.
6. A swimmer visits an athletic trainer for an evaluation of shoulder pain. The evaluation involves a medical history, examination of the shoulder, and clinical decision-making using measurable assessment of functional outcome. The session lasts for 15 minutes.
7. A tennis player consults an athletic trainer for an evaluation of elbow pain. The evaluation includes a medical history, examination of the elbow, and clinical decision-making using standardized patient assessment instruments. The session lasts for 15 minutes.
8. A golfer seeks an evaluation from an athletic trainer for a back injury. The evaluation involves a medical history, examination of the back, and clinical decision-making using measurable assessment of functional outcome. The session lasts for 15 minutes.