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NCCI Edits & Billing for SLP Services

presented by Rick Gawenda, PT

Accrediting Body:

Target Audience:

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Disclosure Statement:

Financial: Rick Gawenda receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Rick Gawenda have no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
This course will teach participants the National Correct Coding Initiative (NCCI) edits and the use of modifier 59 as they apply to outpatient therapy services. The course will thoroughly explain the Medicare “8-minute rule” and definition of substantial per the American Medicare Association for time-based CPT codes. Finally, the course will provide billing scenario’s that will teach speech-language pathologists to bill correctly based on the interventions provided and the amount of time each intervention was provided.

Meet Your Instructor

Rick Gawenda, PT

Rick Gawenda, PT, is founder and President of Gawenda Seminars & Consulting, Inc. He graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Rick is Director of Finance for a physical-therapist-owned private practice with multiple offices located in Southern California. In addition, he was Director of Physical…

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Chapters & Learning Objectives

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1. NCCI Edits & Modifier 59

This chapter will teach participants what NCCI edits are, which insurance carriers use them, and how to bypass the NCCI edits on the claim form by using modifier 59. The chapter will also teach participants how services provided by one discipline can impact the payment on services provided by another discipline when provided on the same date of service in the same organization or facility.

2. Medicare’s “8-Minute Rule” and Definition of Substantial

This chapter will teach participants the “8-minute rule” used by the Medicare program and some other insurance carriers. The chapter will also discuss the American Medical Association definition of substantial for a time-based CPT code and how much time must be provided of a time-based CPT code to bill that CPT code to an insurance carrier. Finally, this chapter will provide billing scenarios that will teach speech-language pathologists to bill correctly based on the interventions provided and the amount of time each intervention was provided.

3. SLP Billing Scenarios

This chapter will provide billing scenarios that will teach speech-language pathologists to bill correctly based on the interventions provided and the amount of time each intervention was provided.

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