How To Use CPT Code 97170

CPT 97170 describes the evaluation of an athletic training session of moderate complexity, involving a medical history, physical activity profile, examination of affected body area, and clinical decision making. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97170?

CPT 97170 can be used to describe the evaluation of an athletic training session of moderate complexity. This code is used when a healthcare provider assesses a patient with one to two health-related issues that affect physical activity. The evaluation includes a medical history, 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. Typically, this evaluation requires 30 minutes of face-to-face time with the patient and/or family.

2. Official Description

The official description of CPT code 97170 is: ‘Athletic training evaluation, moderate complexity, requiring these components: A medical history and physical activity profile with 1-2 comorbidities that affect physical activity; An examination of affected body area and other symptomatic or related systems addressing a total of 3 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 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 of the patient, including any comorbidities that may affect physical activity.
2. Next, the provider conducts a physical activity profile to assess the patient’s current level of physical activity and any limitations.
3. The provider then performs an examination of the affected body area, as well as other symptomatic or related systems, addressing at least three elements related to body structures, physical activity, and/or participation deficiencies.
4. Using standardized patient assessment instruments and/or measurable assessment of functional outcome, the provider engages in clinical decision making of moderate complexity to evaluate the patient’s condition and determine the appropriate course of action.
5. The evaluation typically requires 30 minutes of face-to-face time with the patient and/or family to thoroughly assess and discuss the findings.

4. Qualifying circumstances

CPT 97170 is applicable to patients who have suffered a sports-related injury and require an evaluation of moderate complexity. The patient should have one to two health-related issues that affect physical activity. The evaluation may involve assessing body structures, physical activity, and/or participation deficiencies. The healthcare provider must use standardized patient assessment instruments and/or measurable assessment of functional outcome to make clinical decisions. The evaluation typically requires 30 minutes of face-to-face time with the patient and/or family.

5. When to use CPT code 97170

CPT code 97170 should be used when a healthcare provider performs an evaluation of moderate complexity for a patient with one to two health-related issues that affect physical activity. This code is appropriate when the evaluation includes a medical history, 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 involve 30 minutes of face-to-face time with the patient and/or family.

6. Documentation requirements

To support a claim for CPT 97170, the healthcare provider must document the following information:

• Patient’s medical history and any comorbidities affecting physical activity
• Physical activity profile and limitations
• Examination findings related to the affected body area and other symptomatic or related systems
• Clinical decision making process and use of standardized patient assessment instruments and/or measurable assessment of functional outcome
• Date, start and end time of the 30-minute face-to-face evaluation
• Signature of the healthcare provider performing the evaluation

7. Billing guidelines

When billing for CPT 97170, ensure that the evaluation is of moderate complexity and includes a medical history, 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 involve 30 minutes of face-to-face time with the patient and/or family. It is important to note that CPT code 97170 should not be reported with codes 97166 to 97168 if they have already been performed in the previous seven days. Additionally, consider the location of the evaluation when coding, as there may be different codes for professional and technical components.

8. Historical information

CPT 97170 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. A healthcare provider evaluates a soccer player who has sprained their ankle during a game. The evaluation includes a medical history, physical activity profile, examination of the ankle, and clinical decision making using standardized patient assessment instruments. The provider spends 30 minutes face-to-face with the patient and/or family to discuss the findings and develop a treatment plan.
2. A healthcare provider assesses a gymnast with shoulder pain. The evaluation involves taking a medical history, assessing the patient’s physical activity profile, examining the shoulder, and making clinical decisions using standardized patient assessment instruments. The provider spends 30 minutes face-to-face with the patient and/or family to discuss the evaluation results and recommend appropriate treatment.
3. A healthcare provider evaluates a basketball player with knee pain. The evaluation includes a medical history, physical activity profile, examination of the knee, and clinical decision making using standardized patient assessment instruments. The provider spends 30 minutes face-to-face with the patient and/or family to review the evaluation findings and develop a comprehensive treatment plan.