Comprehensive Coding, Billing and Payment for Outpatient Therapy Services: CPT Codes, CCI Edits, Therapy Cap, ABN & ICD-10

• •Describe service–based vs. time–based CPT codes along with rationale for the use of CPT and L Codes in all outpatient settings


• •Distinguish between column 1/column 2 CCI edits and appropriately append modifier–59 to the correct CPT code(s)


• •Outline the difference between Medicare's "8–Minute Rule" and the definition of "substantial" for time based codes when billing Medicare vs. private insurance carriers


• •Describe the manual medical review process for patients receiving Medicare benefits above the therapy cap dollar threshold


• •Explain when to use an ABN as well as the Multiple Procedure Payment Reduction policy and its impact on payment


• •Discuss ICD–10 coding guidelines and the 7th character as they apply to therapy services

The Right Combination to Keep the Auditors Away While Ensuring Optimal Payment
The cost of providing therapy continues to rise even as insurance carriers (including Medicare) continue to reduce payments. The therapy cap, Multiple Procedure Payment Reduction policy, new subsets of modifier 59 and ICD–10 complicate the billing process for therapists and administrators. Without a proper understanding of the coding requirements and practices, organizations risk leaving money on the table and increase the chances of an audit.
This comprehensive course unlocks the information outpatient providers need to accurately charge for their services. Resources and references are given to help providers stay current with reimbursement guidelines and regulations as they pertain to outpatient therapy services.