Data from 500,000 Evaluative Notes Unearths Key CPT Coding Trends

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- WebPT, the leading rehab therapy software platform, has released intriguing findings based on analysis of the more than half-million evaluative notes it has collected since January 1, 2017, when the Centers for Medicare and Medicaid Services (CMS) began requiring new complexity-based CPT codes for physical and occupational therapy evaluations. The data, collected by the company's 70,000-plus users, identified several trends that could influence future decisions and policies affecting payment rates and the rehab therapy industry as a whole.

The new evaluation codes represented a considerable shift in the way therapists code for initial evaluations, requiring them to identify the level of complexity associated with each individual evaluation. At a high level, WebPT's coding data showed that: the distribution of code usage didn't match CMS's original projections; elderly patients underwent more high-complexity evaluations than other age populations; compared to men, women undergo more evaluations, and their evaluations are more likely to be high complexity; and evaluations in cases involving abnormalities of gait and mobility were more complex than those for other types of diagnoses.

"Though our data is still relatively young, the trends we are seeing show just how important data is in our industry -- especially with respect to future regulatory policies and payment structures," said Dr. Heidi Jannenga, PT, DPT, ATC/L, president and co-founder of WebPT. "Aside from affecting policy, data is absolutely imperative to providers across the care spectrum in terms of shaping future care, as it provides key insights into outcomes and population trends. Specifically to the physical therapy profession, however, it enables us to advocate for the future of our profession and further demonstrate our value as care providers with clinical expertise."

Here are some more detailed takeaways from WebPT's evaluation code analysis: While CMS expected the moderate complexity evaluation code to be used 50% of the time (with the other 50% split evenly between the low and high complexity codes), WebPT's data showed that low-complexity and moderate-complexity codes were each used approximately 45% of the time, with high complexity codes accounting for a little more than 8% of evaluations. Individuals over the age of 50 accounted for the greatest volume of evaluations, with the biggest spike occurring between ages 65 and 72. This means Medicare patients are likely undergoing more therapy evaluations than patients with other insurance types. Women accounted for approximately 30% more evaluations than men. Of the four diagnoses categories, those related to abnormalities of gait and mobility accounted for a greater number of moderate- and high-complexity evaluations, which may be due to the fact that gait and mobility issues are often accompanied by other concurrent injuries and conditions.

For more detailed information on the data collected, visit webpt.com (see also Medicare and Medicaid).