Understanding the Complex World of Therapy Services: Documentation, Coding & Billing for Physical and Occupational Therapy

Course Description:

Physical and occupational therapy services continue to be on the medical record review radar for various Medicare Administrative Contractors, private insurance carriers and workers compensation medical review entities for documentation, coding and billing issues. This seminar will teach participants the necessary components of documentation for the initial evaluation, reevaluation, progress reports, daily notes, discharge reports and the Medicare Part B certification and recertification process that will help participants document the key points in supporting medical necessity and the skilled nature of outpatient therapy services not only for insurance carriers, but for their respective state practice act.

The seminar will teach participants what interventions, techniques and procedures are included within the CPT codes most commonly used by physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants. New and deleted CPT codes for calendar year 2020 will also be explained, including new codes for dry needling, biofeedback and cognitive training. The seminar will teach participants the national correct coding initiative (NCCI) edits and the proper use of Modifier 59 as well as Medicare’s “8-minute rule”, definition of substantial per the American Medical Association, and provide billing scenarios to ensure therapists bill correctly to all insurance carriers, including the Medicare program. Finally, the seminar will teach participants the latest on the annual Medicare therapy threshold, use of the KX modifier, claims exceeding $3,000 in a calendar year, and the new PTA and OTA modifiers the Medicare program will begin using in calendar year 2020 when services are provided in whole or in part by a physical therapist assistant or occupational therapist assistant.

Course Objectives:

  1. Describe and implement the necessary components of an initial evaluation to support the need for skilled therapy services
  2. Identify when a reevaluation is appropriate to perform on a patient and bill to an insurance carrier
  3. List the required and necessary components of a progress report to support the therapy already provided and the need for continued skilled therapy services
  4. Apply strategies to more effectively support medical necessity and skilled services in your daily notes
  5. Describe and implement the necessary components of a discharge report to demonstrate the nature of skilled services provided to support why you should be paid for those services
  6. Understand the certification and recertification process for Medicare Part B therapy services
  7. Distinguish between therapeutic exercise, neuromuscular reeducation & therapeutic activities
  8. Identify how to select the correct CPT code(s) based on interventions and techniques provided and documentation in the medical record
  9. Recite when to append modifier 59 to a CPT code on the claim form and documentation required in the medical record
  10. Explain how to charge correctly for the services you provide under outpatient therapy benefits for Medicare and private insurance carriers
  11. Recall the current status of the annual Medicare therapy threshold and use of KX modifier
  12. Clarify when the new PTA and OTA modifiers must be appended to CPT codes on the claim form for Medicare Part B claims in 2020


8:00AM – 9:30AM – Documentation requirements for evaluations and reevaluations

9:30AM – 10:00AM – Documentation requirements for Progress Reports

10:00AM – 10:15AM – Break

10:15AM – 11:00AM – Documentation requirements for daily notes and discharge reports

11:00AM – 11:15AM – Medicare Part B certification & recertification requirements

11:15AM – 12:00PM – CPT codes most commonly utilized by PT and OT

12:00PM – 1:00PM – Lunch

1:00PM – 1:45PM – CPT codes most commonly utilized by PT and OT (cont)

1:45PM – 2:15PM – NCCI edits and use of Modifier 59

2:15PM – 2:30PM – Medicare “8-minute rule” and definition of substantial

2:30PM – 2:45PM – Break

2:45PM – 3:15PM – Post-Test Billing Scenarios for Medicare Part B & non-Medicare insurance carriers

3:15PM – 3:45PM – Medicare therapy threshold, KX Modifier, & services above $3,000

3:45PM – 4:00PM – New PTA and OTA modifiers for Medicare Part B claims

4:00PM – Conclusion


Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. and Director of Finances for Kinetix Advanced Physical Therapy Inc., a private practice located in southern California. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, skilled nursing facilities, and his peers in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda’s website, www.gawendaseminars.com, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.

Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.

Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.


Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, rehabilitation agencies, home health agencies, comprehensive outpatient rehabilitation facilities, and billing companies.


The course manual will be emailed in a 3-slide per page pdf format to all registrants prior to the date of the seminar. The course manual will be emailed to the participant to the email address included in their registration. There will be NO printed course manuals provided at the seminar. Participants are encouraged to either download the handouts onto their laptop and to bring their laptop to the seminar or print off the pdf version of the handout and bring the handout with them to the seminar.


Written requests for refunds received on or before 2 weeks of the seminar date that you registered to attend, will receive a refund less a $60 processing fee; fees are nonrefundable after this date. There are no refunds for no shows or any other reasons within 14 calendar days of the date of the seminar that you registered to attend. We are not responsible for organization fire walls or computer software issues that may interfere and/or prohibit you from receiving the course handout via email. Email your request for a refund to the conference coordinator: seminars@gawendaseminars.com.


Continuing education units (CEUs) are available for this seminar series. Please refer to each individual seminar for details in your state.


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