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Course Description

An accurate understanding of the coding and documentation process is critical for rehab professionals. Outpatient Therapy CPT Coding, Billing and Documentation for Rehabilitation Reimbursement covers the correct use of CPT codes, G and L Level II codes, and modifiers used by Physical and Occupational Therapists as well as Speech-Language Pathologists in all outpatient settings including private practice, hospital-based, rehab agencies, comprehensive outpatient rehabilitation facilities, skilled nursing facilities and in a patient’s home. Billing scenarios are discussed and reviewed to ensure therapists can accurately charge patients correctly for their services. This course thoroughly reviews Medicare Part B and other third party payer documentation guidelines for initial evaluations, re-evaluations, progress and discharge reports, daily notes, certifications/re-certifications, and plans of care.

Course Objectives

Upon successful completion of this course, participants will be able to:

  • Describe & understand the rationale for the use of CPT, G, & L codes in all outpatient settings
  • Define and distinguish between mutually exclusive edits and column 1/column 2 edits
  • Use the CCI edit chart and appropriately append modifier-59 to the correct CPT code(s)
  • Document appropriately to support the treatments provided when using modifier-59
  • Charge correctly for the services you provide under outpatient therapy benefits
  • Describe and understand Medicare’s “8-Minute Rule” to bill correctly and optimize reimbursement
  • Define “each 15-minutes” and what is a substantial portion for private insurance companies
  • Charge correctly for the services you provide under outpatient therapy benefits
  • Describe and implement the necessary components of documentation to support skilled therapy services for reimbursement
  • Write function-based short and long-term goals based on the patient’s functional deficits
  • Provide the definitions and requirements for developing plan of cares and the certification/recertification process

Rick Gawenda

PT

RICK GAWENDA, PT, is a licensed physical therapist with over 26 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991. Mr. Gawenda is also Director of Finance for Kinetix Advanced Physical Therapy, a private practice with 2 locations. He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies 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 has presented nationally since 2004 and currently presents over 80 dates per year around the United States. Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is a Past President of the Section on Health Policy & Administration of the APTA as well as a 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”.

Financial Disclosure: Rick Gawenda is President and owner of Gawenda Seminars & Consulting. He receives an honorarium for his speaking engagements. He receives royalties for the sale of his online courses.
Non-Financial Disclosure: none to disclose

120 Minutes
Therapy CPT Codes (PT & OT commonly used CPT codes)
15 Minutes
Break
30 Minutes
Therapy CPT Codes (SLP commonly used CPT codes)
30 Minutes
CCI Edits and Modifier 59
30 Minutes
Use of Students and Medicare & non-Medicare Billing Scenarios
60 Minutes
Lunch
75 Minutes
Initial evaluation documentation requirements (subjective intake, plan of carerequirements, function-based goal writing)/Re-evaluations
15 Minutes
Progress Reports
15 Minutes
Break
30 Minutes
Treatment/Daily Note and Discharge Note requirements
30 Minutes
Certification/re-certification

Contact hours pre-approved for:

  • 0.6 CEUs (6.0 Hrs.) OT/COTAs, PT/PTAs, SLPs (unless other wise noted below)
  • CIAO is an AOTA Approved Provider #4119 (OT/COTAs)
  • This course meets PDU requirements for NBCOT (6 PDUs)
  • This course is offered for 0.6 ASHA CEUs (Introductory level, Related area).
  • CIAO is an ASHA Approved Provider #AAWA (SLP)
  • CIAO is an IACET Approved Provider
  • This course has been approved by the American Academy of Professional Coding for 6.0 hrs
  • This activity is provided by the TX Board of PT Examiners Accredited Prov. #1602009
  • This activity meets the continuing competence requirements for PT/PTA license renewal in TX
  • CIAO is an Illinois Approved Provider for PT/PTA Continuing Education
  • 6.0 hrs PT/PTAs in AR, IL, NC, NY, SC, TN(#4095), TX (6 CCUs), VA
  • 7.0 hrs OT/COTAs in FL (CP120117921)(CE Broker 20-333512)

The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.


This course is offered for 0.6 ASHA CEUs (Introductory level, Related area).


CIAO Automatically reports to CE Broker for Florida Occupational and Physical Therapists and Assistants. Florida SLPs can either use the ASHA CE Participant Form (Bubble Sheet) or self-submit through CE Broker.


CIAO is accredited by the International Association for Continuing Education and Training (IACET). CIAO complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, CIAO is accredited to issue the IACET CEU.


CIAO is recognized on the NBCOT Provider Registry (meets PDU requirements for NBCOT)


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