How To Use CPT Code 97171

CPT 97171 describes the evaluation of athletic training services for patients with complex medical conditions that affect physical activity. 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 97171?

CPT 97171 can be used to describe the evaluation of athletic training services provided to patients with complex medical conditions that impact their physical activity. This code is used when a healthcare provider spends 45 minutes face-to-face with the patient and/or their family, conducting a comprehensive assessment and evaluation of the patient’s condition.

2. Official Description

The official description of CPT code 97171 is: ‘Athletic training evaluation, high complexity, requiring a medical history and physical activity profile, with 3 or more comorbidities that affect physical activity; a comprehensive examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; clinical presentation with unstable and unpredictable characteristics; and clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 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, focusing on any comorbidities that may impact their physical activity.
2. A comprehensive examination of the patient’s body systems is conducted using standardized tests and measures. This examination addresses at least 4 elements related to body structures, physical activity, and/or participation deficiencies.
3. The clinical presentation of the patient is assessed, taking into account any unstable and unpredictable characteristics.
4. The healthcare provider uses a standardized patient assessment instrument and/or measurable assessment of functional outcome to make clinical decisions of high complexity.
5. The evaluation typically takes 45 minutes of face-to-face time with the patient and/or their family.

4. Qualifying circumstances

Patients eligible for CPT 97171 are those with complex medical conditions that affect their physical activity. These patients must have three or more comorbidities that impact their physical activity. The clinical presentation of the patient must also exhibit unstable and unpredictable characteristics. The evaluation must be conducted by a healthcare provider who is trained in athletic training services and has the expertise to assess and evaluate patients with complex medical conditions.

5. When to use CPT code 97171

CPT code 97171 should be used when a healthcare provider spends 45 minutes face-to-face with the patient and/or their family, conducting a high complexity evaluation of athletic training services. This code is appropriate for patients with complex medical conditions that affect their physical activity and require a comprehensive assessment and evaluation.

6. Documentation requirements

To support a claim for CPT 97171, the healthcare provider must document the following information:

• Medical history and physical activity profile of the patient
• Comprehensive examination of body systems using standardized tests and measures
• Specific elements addressed during the examination, related to body structures, physical activity, and/or participation deficiencies
• Clinical presentation of the patient, including any unstable and unpredictable characteristics
• Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome
• Date, start and end time of the 45-minute face-to-face session
• Signature of the healthcare provider conducting the evaluation

7. Billing guidelines

When billing for CPT 97171, ensure that the healthcare provider spends 45 minutes face-to-face with the patient and/or their family, conducting a high complexity evaluation of athletic training services. This code should not be reported with other codes unless additional services are provided that are distinct and separate from the evaluation. It is important to accurately document the complexity and extent of the evaluation to support the use of CPT 97171.

8. Historical information

CPT 97171 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 conducting a high complexity evaluation of athletic training services for a patient with multiple comorbidities affecting physical activity.
2. An athletic trainer assessing a patient with an unstable and unpredictable clinical presentation, conducting a comprehensive examination of body systems and making clinical decisions of high complexity.
3. A healthcare provider spending 45 minutes face-to-face with a patient and their family, evaluating their physical activity limitations and developing a treatment plan based on standardized tests and measures.
4. An athletic trainer evaluating a patient with complex medical conditions that impact their physical activity, using a standardized patient assessment instrument and measurable assessment of functional outcome to guide clinical decision making.
5. A healthcare provider conducting a high complexity evaluation of athletic training services for a patient with three or more comorbidities, addressing body structures, physical activity, and participation deficiencies during the examination.
6. An athletic trainer spending 45 minutes face-to-face with a patient and their family, evaluating their clinical presentation and making clinical decisions of high complexity using standardized tests and measures.
7. A healthcare provider assessing a patient with complex medical conditions that affect their physical activity, conducting a comprehensive evaluation and documenting the findings in the medical record.
8. An athletic trainer conducting a high complexity evaluation of athletic training services for a patient with an unstable and unpredictable clinical presentation, using a standardized patient assessment instrument to guide clinical decision making.
9. A healthcare provider spending 45 minutes face-to-face with a patient and their family, evaluating their physical activity limitations and developing a personalized treatment plan based on the assessment findings.
10. An athletic trainer evaluating a patient with complex medical conditions that impact their physical activity, conducting a comprehensive examination and documenting the results for further treatment planning.