How To Use CPT Code 97172

CPT 97172 describes the re-evaluation of an established plan of care for athletic training, specifically for patients recovering from sports injuries. 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 97172?

CPT 97172 can be used to describe the re-evaluation of an established plan of care for athletic training. This code is specifically used when there has been a documented change in the patient’s functional status and requires a revised plan of care. The provider spends approximately 20 minutes face-to-face with the patient and/or family during this re-evaluation.

2. Official Description

The official description of CPT code 97172 is: ‘Re-evaluation of athletic training established plan of care requiring these components: An assessment of patient’s current functional status when there is a documented change; and A revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome with an update in management options, goals, and interventions. Typically, 20 minutes are spent face-to-face with the patient and/or family.’

3. Procedure

1. The provider assesses the patient’s current functional status, specifically looking for any documented changes.
2. A revised plan of care is developed using a standardized patient assessment instrument and/or measurable assessment of functional outcome.
3. The provider schedules a 20-minute face-to-face session with the patient and/or family.
4. During the session, the provider evaluates the patient’s current status and progress, revises the goals, management options, and therapeutic interventions of the plan of care.
5. The provider may also discuss any necessary updates or modifications to the treatment plan.

4. Qualifying circumstances

CPT 97172 is used for patients who are recovering from sports injuries and have an established plan of care for athletic training. This code is specifically used when there has been a documented change in the patient’s functional status, requiring a re-evaluation of the plan of care. The provider must spend approximately 20 minutes face-to-face with the patient and/or family during this re-evaluation.

5. When to use CPT code 97172

CPT code 97172 should be used when there has been a documented change in the patient’s functional status and a re-evaluation of the established plan of care for athletic training is necessary. The provider must spend approximately 20 minutes face-to-face with the patient and/or family during this re-evaluation. This code should not be used for initial evaluations or routine follow-up visits.

6. Documentation requirements

To support a claim for CPT 97172, the provider must document the following information:

• Documentation of the patient’s current functional status and any documented changes
• Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome
• Date, start and end time of the 20-minute face-to-face session
• Updates to the management options, goals, and interventions of the plan of care
• Any necessary modifications or updates to the treatment plan
• Signature of the provider conducting the re-evaluation

7. Billing guidelines

When billing for CPT 97172, ensure that the provider spends approximately 20 minutes face-to-face with the patient and/or family during the re-evaluation. This code should not be reported with other codes for initial evaluations or routine follow-up visits. It is important to follow the specific guidelines and requirements set by the payer when submitting claims for CPT 97172.

8. Historical information

CPT 97172 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 patient recovering from a knee injury undergoes a re-evaluation of their established plan of care for athletic training. The provider assesses the patient’s current functional status, revises the plan of care, and spends 20 minutes face-to-face with the patient and their family.
2. An athlete with a shoulder injury requires a re-evaluation of their athletic training plan of care. The provider assesses the patient’s functional status, updates the plan of care, and spends 20 minutes face-to-face with the patient and their family.
3. A soccer player recovering from an ankle sprain undergoes a re-evaluation of their established plan of care for athletic training. The provider assesses the patient’s current functional status, modifies the plan of care, and spends 20 minutes face-to-face with the patient and their family.
4. A gymnast with a wrist injury requires a re-evaluation of their athletic training plan of care. The provider assesses the patient’s functional status, adjusts the plan of care, and spends 20 minutes face-to-face with the patient and their family.
5. A basketball player recovering from a concussion undergoes a re-evaluation of their established plan of care for athletic training. The provider assesses the patient’s current functional status, updates the plan of care, and spends 20 minutes face-to-face with the patient and their family.
6. A runner with a hamstring strain requires a re-evaluation of their athletic training plan of care. The provider assesses the patient’s functional status, revises the plan of care, and spends 20 minutes face-to-face with the patient and their family.
7. A swimmer recovering from a shoulder injury undergoes a re-evaluation of their established plan of care for athletic training. The provider assesses the patient’s current functional status, modifies the plan of care, and spends 20 minutes face-to-face with the patient and their family.
8. A football player with a concussion requires a re-evaluation of their athletic training plan of care. The provider assesses the patient’s functional status, adjusts the plan of care, and spends 20 minutes face-to-face with the patient and their family.