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Evaluation code use

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Dear Group,

Would appreciate assistance with finding CMS regulations regarding 97001, PT

Evaluation and 97003, OT Evaluation, as well as what you routinely do.

The scenario is that a therapist sees an outpatient after the patient was seen

by a provider in our system. The patient is from out of town and will be getting

on-going PT or OT once he/she returns home, but the surgeon wants the patient

started right away with specific things in mind. The therapist here needs to

evaluate the patient and then proceed with treatment. The therapist where the

patient lives - it seems that he or she would certainly need to do the same. Is

it allowable for both to submit initial evaluation charges? Will the second one

be denied? It also happens the other way around, when a patient decides to

change sites and come here, but has been seen elsewhere already for therapy.

So.., the patient is changing sites, but not exactly changing the setting - both

are outpatient settings.

Many thanks for any assistance you can provide - citings in the CMS regs,

suggestions on resources, etc.

Jackins, P.T.

Manager

Exercise Training Center, Eastside Specialty Center

Box 354745; 4245 Roosevelt Way NE

University of Washington Medical Center

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