Exploring Current Procedural Terminology Codes for Physical Therapist Evaluations in the United States: Results of a Feasibility Study.
Kat K Rethman, Cody J Mansfield, Julie A Stephens and 4 others
PMID 41918221WHAT IT FOUND
US outpatient orthopedic physical therapists rating the same 15 patient notes agreed poorly on which complexity code to bill, getting the code right only 49% of the time.
Low complexity cases were coded correctly 94% of the time, moderate 32%, high 21%.
Key findings
01It was feasible to run the study: the target of 20 therapists was reached, all 20 completed both rating sessions, and all finished within three weeks.
02Therapists chose the correct complexity code against the experts' gold-standard answers for only 49% of cases overall. Accuracy was 94% for low complexity cases but only 32% for moderate and 21% for high complexity cases.
03Agreement between different therapists about which code to bill was poor, and each therapist's own answers matched only moderately when the same cases were rated again one to two weeks later.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Therapists rated written notes rather than live patients, which the authors name as the main limitation. How they would code in a real examination is not known. Single site, one institution's training and documentation culture. The authors say the results cannot be generalised and call for a larger multisite study. Only 20 therapists, recruited by convenience as the first volunteers, and the target was only just reached: four of the original 20 dropped out before the study started and a second recruitment email was needed. Reliability calculated within each complexity level (five cases each) is not trustworthy, because there were so few cases and only three possible answers. The authors describe this (the kappa paradox) and say these particular results should be read with caution.
Declared interests
Funded by a grant from the Ohio Physical Therapy Association, which the authors state played no role in the design, conduct or reporting of the study. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the 49% figure as proof that outpatient orthopedic therapists cannot judge patient complexity. In this study they never saw a live patient, only de-identified written notes, and the reliability figures for each complexity level rest on just five cases with three possible answers, which the authors say cannot be interpreted reliably on their own.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →