One of the most common questions I receive is when a 7th character is required on an ICD-10 code, how do I know if the 7th character should be the character “D” or character “S”? The use of the 7th character, in my opinion, is one of the most confusing for physical and occupational therapists as well as speech-language pathologists to understand. Below, I will answer the question of when to use “D” or “S” when a 7th character is required. If the reason for therapy is a result of an injury and the ICD-10 code requires a 7th character

Beginning with dates of service on and after January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) will begin applying the therapy cap limits to hospitals in the state of Maryland. Up until then, the therapy cap limits do not apply to hospitals in Maryland since they are not paid under the Medicare Physician Fee Schedule, but rather, the Maryland All-Payer Model. To read the detailed update, click

In mid-January 2015, CMS approved the Recovery Auditors to begin reviewing Outpatient Therapy Threshold claims (those over the $3700 threshold) that were paid March 1, 2014 through December 31, 2014. In an effort to minimize provider burden, CMS set restrictions on the number of Additional Documentation Requests (ADRs) that could be sent related to these claims, as shown below.

The Centers for Medicare and Medicaid Services (CMS) has issued guidance regarding clarification of using initials in lieu of a full signature for amended or delayed entries into the medical record. This change will

With the implementation of ICD-10 beginning on October 1, 2015, I am often asked about this supposedly “grace period” that the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) agreed to back on July 6, 2015 and how it will help providers if they do not select the most appropriate ICD-10 code for the Medicare beneficiary. To clarify, CMS and the AMA are not calling this a “grace period”, rather, is calling it ICD-10 flexibilities. CMS published a question and answer document concerning the CMS/AMA Joint Announcement and guidance regarding ICD-10 flexibilities and here is

Now that the United States has transitioned to ICD-10 for services provided on or after October 1, 2015, a question I am often asked is do we have to obtain new or updated orders from the physician for Medicare beneficiaries receiving outpatient therapy services. The Centers for Medicare and Medicaid Services (CMS) has provided an updated answer to this question. CMS is

Wisconsin Physician Services (WPS), Medicare Administrative Contractor for the states of Indiana and Michigan will be hosting 2 separate seminars on October 14, 2015 in Fort Wayne, IN. The first will explore the coverage criteria and documentation requirements for Physical Therapy, Occupational Therapy, and Speech Language Pathology.  In this interactive session we will review the coverage criteria as well as documentation examples of: Evaluation/Reevaluation Plans of Care Daily Notes  Treatment Plans  G Codes/Severity Complexity Modifiers For registration details, click HERE. The second seminar will answer the following questions: Do you understand the billing and payment regulations for outpatient rehabilitation therapy?

One of the most common two questions I receive is when a 7th character is required on an ICD-10 code, how do I know if the 7th character should be the character “A” or character “D”? Also, since I am doing an initial evaluation, shouldn’t the 7th character always be an “A” on that first visit and then change to character “D” for follow up visits? The answer to the second question is “not necessarily”. The use of the 7th character, in my opinion, is one of the most confusing for physical and occupational therapists as well as speech-language pathologists