ICD-10 diagnosis codes are valid from October 1 of one year until September 30 of the following year. This means that on October 1, 2017, providers will need to be using ICD-10 Fiscal Year 2018 codes for dates of service on and after October 1, 2017 thru September 30, 2018. In Chapter 5 of the Tabular Section of the ICD-10 book, there are new descriptions and examples of developmental disorders of scholastic skills, eating disorders and sexual arousal disorders. In Chapter 7, there are new ICD-10 codes for visual disturbances and blindness. In Chapter 13, there are new ICD-10 codes

Do therapy orders for Medicare Part B patients referred to outpatient therapy need to be timed by the physician who is ordering the therapy? Do signed plans of care need to be timed by the physician? In addition, do notes written by a therapist or an assistant have to be timed as well as dated? The answer depends on your practice setting. If you are providing outpatient therapy in a hospital outpatient therapy department or clinic, the Conditions of

On September 7, 2017, the Centers for Medicare and Medicaid Services (CMS) selected Palmetto GBA as the A/B Medicare Administrative Contractor (MAC) for Jurisdiction J. Jurisdiction J includes the states of Alabama, Georgia and Tennessee. The transition date to Palmetto GBA will be January 29, 2018 for non-private practice settings and February 26, 2018 for private practice settings. For additional information, click

I receive many questions regarding certifications and recertifications for Part B therapy services. Some of the most common questions I receive are the following: How long is a certification and recertification valid for under Medicare Part B outpatient therapy services? How soon must a plan of care be signed by a physician or NPP to be considered timely under Medicare Part B rules and regulations? Who can sign a plan of care certifying and recertifying for outpatient therapy services under the Medicare program? What is delayed certification and recertification? What are some possible justifications to support delayed certification or recertification?

Private practices and facilities (skilled nursing facilities, rehab agencies and hospitals) are reporting difficulty getting paid for outpatient therapy claims with Humana’s commercial and Medicare Advantage insurance plans. The American Physical Therapy Association (APTA) has received many complaints from their members regarding the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers’ rates through the MPPR, confusion around Humana’s approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim. APTA staff have been in discussion with a representative from Humana to facilitate a

The Centers for Medicare and Medicaid Services has released the National Correct Coding Initiative (NCCI) Version 23.3 edits. Version 23.3 is in effect for dates of services October 1 – December 31, 2017.     Gawenda Seminars & Consulting has created a “cheat sheet” for the use of modifier 59 in outpatient therapy. This “cheat sheet” includes the most commonly used CPT codes by PT, OT and SLP and lists what can and can’t be billed on the same date of service by the same provider and tells you which CPT codes require modifier 59 when provided on the same

On January 12, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule which would specify the qualifications needed for qualified practitioners to furnish and fabricate, and qualified suppliers to fabricate prosthetics and custom- fabricated orthotics; accreditation requirements that qualified suppliers must meet in order to bill for prosthetics and custom-fabricated orthotics; requirements that an organization must meet in order to accredit qualified suppliers to bill for prosthetics and custom-fabricated orthotics; and a timeframe by which qualified practitioners and qualified suppliers must meet the applicable licensure, certification, and accreditation requirements. In addition, this rule would remove the

The 2018 CPT codes have been officially released by the American Medical Association (AMA) and there are several changes that will impact outpatient physical and occupational therapy services. CPT codes, description, and material are copyright 2017 AMA. CPT is a trademark of the AMA. 2018 CPT code changes impact the following CPT codes:  Multi-layer compression system CPT codes 29582 and 29583 Orthotic and management training (CPT code 97760) Prosthetic management and training (CPT code 97761) Orthotic/prosthetic checkout (CPT Code 97762) Development of cognitive skills (CPT code 97532) Lets begin with the multi-layer compression system CPT codes. For dates of service