Billing and NCCI Edits: OT and PT

presented by Rick Gawenda, PT

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Disclosure Statement:

Financial: Rick Gawenda receives compensation from Gawenda Seminars & Consulting, Inc., and MedBridge for this course.

Nonfinancial: Rick Gawenda has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 65 Minutes; Learning Assessment Time: 19 Minutes

This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare "8-minute rule" and definition of "substantial" per the American Medicare Association for time-based CPT codes. Finally, the course will provide billing scenarios that will teach physical and occupational therapists, physical therapist assistants, and occupational therapy assistants to bill correctly based on the interventions provided and the amount of time each intervention was provided.

Learning Objectives

Distinguish which settings NCCI edits apply to and how often they are updated
Distinguish how one discipline's billing can make another discipline's billing require modifier 59
Conclude which CPT code requires modifier 59 be appended to it on the claim form
Execute Medicare's 8-minute rule and definition of "substantial" to bill correctly
Calculate the correct number of units to bill based on CPT codes provided and amount of time spent providing each code

Meet Your Instructor

Rick Gawenda, PT

Rick Gawenda is founder and president of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in physical therapy from Wayne State University in Detroit. Rick is director of finance for a physical therapist-owned private practice with multiple offices located in Southern California. In addition, he was director of physical…

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Chapters & Learning Objectives

1. NCCI Edits and Modifier 59

This chapter will teach participants what NCCI edits are, which insurance carriers use them, and how to bypass the NCCI edits on the claim form by using modifier 59. The chapter will also teach participants how services provided by one discipline can impact the payment of services provided by another discipline when provided on the same date of service in the same organization or facility.

2. Medicare’s 8-Minute Rule and Definition of Substantial

This chapter will teach participants the 8-minute rule used by the Medicare program and some other insurance carriers. The chapter will also discuss the American Medical Association’s definition of “substantial” in relation to time-based CPT codes and how much time must be provided of a time-based CPT code to bill that CPT code to an insurance carrier. Finally, this chapter will provide billing scenarios that will teach physical and occupational therapists, physical therapist assistants, and occupational therapy assistants to bill correctly based on the interventions provided and the amount of time each intervention was provided.

3. PT and OT Billing Scenarios

This chapter will provide billing scenarios that will teach physical and occupational therapists, physical therapist assistants, and occupational therapy assistants to bill correctly based on the interventions provided and the amount of time each intervention was provided.

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