CPT® Code 97167

Occupational therapy evaluation, high complexity, is a comprehensive assessment process designed to evaluate a patient's functional abilities and limitations. This evaluation is crucial for developing a tailored treatment plan that addresses the specific needs of the patient. The procedure begins with the collection of an occupational profile and a thorough medical and therapy history, which involves reviewing existing medical and therapy records. Additionally, there is an extensive examination of the patient's physical, cognitive, and psychosocial history, all of which are pertinent to understanding their current functional performance. The occupational therapist identifies five or more performance deficits that may relate to physical, cognitive, or psychosocial skills, which can lead to activity limitations or participation restrictions in daily life. The evaluation process also requires high-level clinical decision-making, characterized by the analysis of the patient profile and data derived from comprehensive assessments. This analysis takes into account the patient's comorbidities, which can significantly impact their occupational performance. The complexity of the evaluation is further heightened by the necessity for significant modifications of tasks or assistance, whether physical or verbal, to enable the patient to complete the evaluation components effectively. Typically, this evaluation process involves approximately 60 minutes of face-to-face interaction with the patient and/or their family, ensuring a thorough understanding of the patient's needs and circumstances.