The fiscal year (FY) 2022 ICD-10-CM codes are to be used for patient encounters occurring from October 1, 2021 through September 30, 2022 as well as for discharges occurring from October 1, 2021 through September 30, 2022. ICD-10-CM codes are used by physical therapists, occupational therapists and speech-language pathologists not only to report the physicians’ medical diagnosis(es) for therapy services, but where allowed, a therapy and/or treatment diagnosis(es) of why a patient requires outpatient physical, occupational and/or speech therapy services. Changes occuring on October 1, 2021 include ICD-10-CM codes that are used by all 3 disciplines (physical therapy, occupational therapy

Fiscal Year (FY) 2022 ICD-10-CM codes become effective with dates of service between October 1, 2021 – September 30, 2022. In addition, the FY 2022 ICD-10-CM codes are to be used for discharges occurring from October 1, 2021 through September 30, 2022. In this article, I will answer the following questions: In the tabular section of the ICD-10-CM book, I often see Excludes 1 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 1”. What does Excludes 1 mean and can you give an example? In the tabular section of the ICD-10-CM book, I often see Excludes

UnitedHealthcare Community Plan has released a revised Coverage Determination Guideline (CDG) for outpatient physical and occupational therapy services for the following states: Arizona California Hawaii Kansas Maryland Michigan New York Ohio Rhode Island Virginia Washington Wisconsin Changes include Required Documentation for the following: Initial Therapy Evaluation/Initial Therapy Visit Requests Request for Continuation of Therapy Visits Progress Reports Re-evaluations Visit Guidelines Signed and Dated Physician Orders To access the revised policy, click I hope you found this information helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc.

UHC Community Plan of New Jersey has announced they will be adding CPT codes that are billed by physical therapists, occupational therapists and speech-language pathologists to their list of codes that require Advance Notification and Prior Authorization. To access the revised list, click I hope you found this information helpful. Thank you for being a Gold Member!

Per BCBS of Michigan, eviCore, beginning July 1, 2021, will no longer mail paper copies of the Practice Profile Summary, which includes information about your assigned category for outpatient physical therapy services, to health care providers. Instead, eviCore will post category updates on the first business day of February and August each year beginning in August 2021. Follow these steps to access your Practice Profile Summary and obtain your category: I hope you found this information helpful. Thank you for being a Gold Member!

The Centers for Medicare and Medicaid Services (CMS) has published the National Correct Coding Initiative (NCCI) edits, Version 27.3, for dates of service October 1, 2021 – December 31, 2021. These NCCI edits are not only used by traditional Medicare, but also by many state Medicaid and Managed Medicaid plans as well as many commercial insurance carriers and workers compensation insurance carriers. As Gawenda Seminars & Consulting (GSC) has done every quarter for their Gold Members, GSC has published their “cheat sheet” for the use of modifier 59 in outpatient therapy under NCCI edit Version 27.3. This “cheat sheet” includes

With an increase in private practices, especially solo practices, providing outpatient therapy in a patient’s home, I am receiving more and more questions regarding the regulatory, billing and payment rules. In addition, due to COVID-19, rehabilitation agencies and hospital outpatient therapy departments are sending their therapists to a patient’s home to provide outpatient therapy services. In this article, I will provide answers to the following questions: Does the Medicare program pay for outpatient therapy provided in a beneficiaries home? For Medicare purposes, what is considered a patient’s home? Do Medicare Advantage plans and commercial insurance carriers pay for outpatient therapy

There has been a lot of discussion on Medicare Advantage plans lately on several of the social media platforms. While social media can be a good place to seek information, the information that is shared is not always correct or perhaps, not correct for your specific situation and/or question. In this article, I will provide answers to the following questions I am routinely asked: Does the annual therapy threshold that applies to traditional Medicare beneficiaries also automatically apply to all Medicare Advantage plans and their beneficiaries? Does the 10th visit Progress Report that applies to traditional Medicare patients also apply