National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices in outpatient therapy as well as other services. Modifier 59 is used by outpatient therapy providers to bypass certain NCCI edits and allow the payment of more than 1 CPT code billed on the same day that an insurance carrier may consider should be bundled and separate payment should not be made. Because of this, modifier 59 is not only the most commonly used modifier, it is also the most commonly abused modifier. In addition, the need to use modifier 59 is not only within the same discipline but may also be required when a patient is receiving multiple disciplines from the same provider on the same date of service. Version 29.0 becomes effective with dates of service between January 1 – March 31, 2023.
This 1-hour webinar program will explain NCCI edits, the use of modifier 59 and what code(s) to append modifier 59 to on the claim form as well as provide the participants with any significant changes to the procedure-to-procedure (PTP) edits effective beginning on January 1, 2023 that will impact outpatient physical, occupational and speech therapy services. In addition, the webinar will provide detailed and realistic examples when providers of outpatient therapy services would utilize modifier 59. Examples will include all 3 disciplines as well as how speech therapy billing impacts the physical and occupational therapy codes billed the same day. Lastly, participants will receive Gawenda Seminars & Consulting NCCI Version 29.0 “cheat sheet” to assist them in knowing when to apply modifier 59 to a CPT code on the claim form. In addition, the webinar will explain how the reinstated NCCI edits will impact the billing of outpatient therapy services to commercial insurance carriers such as Aetna, Anthem BC, Humana and many others.
At the conclusion of this webinar presentation, participants will be able to:
- Describe and understand column 1/column 2 NCCI edits and which CPT code(s) requires modifier 59
- Be able to use the NCCI edit “cheat sheet” to append modifier-59 to the correct CPT code(S) on the claim form
- Recite how one discipline’s billing may cause another discipline’s billing to require modifier 59
- Understand the documentation that must be present in the medical record to support the use of modifier 59
- Identify at least 3 changes to NCCI edits as they pertain to outpatient physical, occupational and speech therapy services with Version 29.0 compared to Version 28.3
- Summarize the current payment status of a physical or occupational therapy evaluation or reevaluation when billed on the same date of service as an emergency department visit
- Explain the current status of the XE, XP, XS, and XU subsets of modifier 59
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, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. 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, speech-language pathologists, 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, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.
In addition to the expertise and advice presented during this webinar conference, you’ll also receive a handout (in PDF format) that will include related reference links as well as Gawenda Seminars & Consulting NCCI Edit Version 29.0 “Cheat Sheet” for use of modifier 59 in outpatient therapy.
This webinar has not been submitted to any state board or national organization for CEU approval. A certificate of attendance will be available upon completion of the webinar for each participant and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference. We provide no additional information for CEU approval.
There are no refunds for no shows or any other reasons once you register and payment is received. We are not responsible for organization firewalls or computer software issues that may interfere and/or prohibit your connection to the webinar portion of the presentation.
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Note: Android Smart Phones (i.e. iPhone) are not compatible.
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