Seminar Detail

2019 CPT Update: Get Paid Quickly & Correctly! Coding, Billing and Documentation Strategies for Physical and Occupational Therapy Services
2019 CPT Update: Get Paid Quickly & Correctly! Coding, Billing and Documentation Strategies for Physical and Occupational Therapy Services

Where:   FAIRFAX, VA

When:  Friday, February 22, 2019 at 8:00 AM - 4:00 PM

This event is not currently available for purchase.

For more information: Call (800) 844-8260
Course Description:

Are you losing money? Do the documentation and CPT rules and regulations have you scratching your head?

Staying current with the ever-changing payment and documentation rules and regulations is critical to ensure that you are paid correctly and in a timely manner.

This exciting and up-to-date seminar is your #1 source for PT & OT CPT codes, use of modifier 59, billing and documentation rules and regulations.

Join insurance billing expert Rick Gawenda, PT, and learn how to accurately navigate the reimbursement guidelines and regulations as they pertain to outpatient therapy services. Billing scenarios will be reviewed to ensure you can accurately charge patients correctly for their service for Medicare and non-Medicare beneficiaries. At the end of the day, you will leave with a new found understanding of why claims are denied and how to maximize your reimbursement legally and ethically.

Attend and you will learn how to accurately:
  • Bill the appropriate PT & OT evaluation codes using the required components
  • Use CPT and L codes in all outpatient settings
  • Differentiate between Column 1 and Column 2 NCCI Edits
  • Use the new subsets of modifier 59 as they apply to outpatient therapy
  • Maximize reimbursement when faced with Medicare’s “8-Minute Rule”
  • Code for “each 15-minutes” and what is considered “substantial” portion for private insurance companies
  • Implement the necessary components of documentation to support skilled therapy services for payment
  • Write function-based short- and long-term goals based on the patient’s functional deficits
  • Provide the requirements for developing plan of care and the certification/recertification process
This seminar is applicable to rehabilitation professionals in all outpatient settings, including private practice, hospital-based rehab agencies, comprehensive outpatient facilities, skilled nursing facilities, and even in your patient’s home.

  1. Summarize the required components to bill the appropriate PT & OT evaluation codes.
  2. Articulate the rationale for the use of CPT and L codes in all outpatient settings.
  3. Differentiate between column 1/column 2 NCCI edits.
  4. Explain which CPT code(s) require modifier 59 appended to them on the claim form.
  5. Describe Medicare’s “8-Minute Rule’ to bill correctly and optimize reimbursement.
  6. Define “each 15-minutes” and what is a substantial portion for private insurance companies.
  7. Implement the necessary components of documentation to support skilled therapy services for payment.
  8. Develop function-based short- and long-term goals based on the patient’s functional deficits.
  9. Recite the definitions and requirements for developing plan of care and the certification/recertification process.

Therapy CPT and L Codes
  • Need to know components of Eval Codes
  • Time-based vs. service-based CPT codes
  • CPT code to bill based on your documentation and purpose of the activity
  • Settings that can be billed for pre-fabricated and custom-fabricated orthotics without needing a DME license
  • Accurate use of modifier-59 and how to document and support it
  • Differentiate between Column 1 and Column 2 NCCI Edits
NEW! Medicare’s “8 Minute Rule” and Post-Test Billing Scenarios
  • Bill the correct number of units for timed-based codes for Medicare and non-Medicare insurance payers
  • When to bill using Substantial Portion Methodology (SPM) for a time-based CPT code
Initial Evaluation Documentation Requirements
  • History of current illness/injury
  • Prior and current functional status
  • Objective data, functional deficits, and function-based goal writing
  • Plan of care requirements
Re-Evaluation, Progress Reports and Daily Documentation Requirements
  • Implement the necessary components of a progress report to:
    • Support the therapy already provided
    • The need for continued skilled therapy services
  • Medical Necessity
    • Apply strategies to more effectively support medical necessity and skilled services in your daily notes
  • When re-evaluation is appropriate to perform on a patient, then bill to an insurance carrier
  • Certification and re-certification process for Medicare Part B therapy services
  • Required components of a Medicare certification/re-certification
  • What is considered a timely certification versus a delayed certification
Target Audience

  • Physical Therapists
  • Physical Therapist Assistants
  • Occupational Therapists
  • Occupational Therapy Assistants
  • Rehab Directors
  • Managers and Supervisors
  • Rehab Billers and Coders
  • Physicians
  • Nursing Home Administrators
  • Office Manages and Front Office Staff
  • Compliance Officers


Rick Gawenda, PT, is a licensed physical therapist with 27 years of clinical and consulting experience. A former Director of Rehabilitation and the founder of Gawenda Seminars & Consulting, he has provided valuable education and consultation to skilled nursing facilities, hospitals, private practices, and rehabilitation agencies in the areas of CPT/ICD-10 coding, billing PQRS, documentation compliance, revenue enhancement, practice management, and denial management as they relate to both outpatient and inpatient therapy services.

Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States. He is 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.

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

Speaker Disclosures:

Financial: Rick Gawenda is the founder and president of Gawanda Seminars & Consulting, Inc. He has an employment relationship with Kinetix Advanced Physical Therapy. He receives royalties as an author for HCPro, Inc. He receives a speaking honorarium from PESI, Inc.

Non-financial: Rick Gawenda has no relevant non-financial relationships to disclose.
This program has the prior approval of the American Academy of Professional Coders (AAPC) for 6.0 continuing education hours. Granting of prior approval in no way constitutes endorsement by the AAPC of the program content or the program sponsor. AAPC approval good thru 12/31/2019.

This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 6.25 clock hours and 6.25 participant hours. Full attendance is required; no partial credits will be offered for partial attendance.

PESI, Inc. is an AOTA Approved Provider of continuing education. Provider #: 3322. Full attendance at this course qualifies for 6.0 contact hours or .6 CEUs in the Category of Domain of OT and Occupational Therapy Process. Partial credit will be issued for partial attendance. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. Course Level: Intermediate.

This activity consists of 6.25 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary per state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

MARYLAND PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS: This course meets the basic criteria of the Maryland State Board of Physical Therapy Examiners and has been approved for .6 CEUs.

This course has been approved for 6.25 contact hours by the Virginia Physical Therapy Association. Approval #: CEUL026428.

This activity qualifies for 380 minutes of instructional content as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific requirements.

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