Re-Evaluations

When and how to use the codes.

What is a Re-Evaluation?

A Re-evaluation of a patient's condition may be provided during an episode of care when "the professional assessment of a clinician indicates a significant improvement, or decline, or change in the patient's condition or functional status that was not anticipated in the plan of care".

A re-evaluation is not a routine, recurring service but is focused on evaluation of progress toward current goals, making a professional judgment about continued care, modifying goals and/or treatment or terminating services.

When to Perform a Re-Evaluation

Re-evaluations can be performed when (1) a plan of care is recertified and (2) prior to discharge.

Per Medicare Benefit Policy Manual Chapter 15, indications for a re-evaluation include:

• New clinical findings

• A significant change in the patient's condition

• Failure to respond to the therapeutic interventions outlined in the plan of care

• Prior to discharge

How:

The re-evaluation code has been added to the Progress with Re-Certification and Discharge Chart Templates for PT/OT.

SLPs do not have a re-evaluation code; the appropriate evaluation code is to be billed.

Why Not At Every Progress Visit?

Because  "continuous assessment of the patient's progress is a component of ongoing therapy services and is not payable as a re-evaluation".

Let us know if you have any questions!