59 Modifier for Physical Therapy, Occupational Therapy: Medicare NCCI Edits

CMS Link: www.cms.gov/medicare/coding-b...
Detailed Description of the Video
*Title:* Understanding NCCI Edits for Therapy Services
*Presented by:* Tony Maritato, sponsored by Hippo Scribe and Yansen
*Summary:*
In this instructional video, Tony Maritato addresses common questions regarding the latest National Correct Coding Initiative (NCCI) edits for physical therapy, occupational therapy, and speech-language pathology. The video aims to help healthcare providers navigate the complexities of NCCI edits by showing them where to find accurate and up-to-date information and how to interpret it.
*Key Points Covered:*
1. *Introduction and Sponsorship:*
- Tony introduces himself and acknowledges the sponsorship from Hippo Scribe and Yansen.
- He highlights the importance of understanding current NCCI edits for various therapy services.
2. *Locating NCCI Edits:*
- Tony guides viewers through the process of finding NCCI edits on the Medicare website.
- He demonstrates how to perform a quick search for "CMS NCCI edits" and navigate to the correct page.
- Viewers are shown how to locate the "Medicare NCCI Procedure-to-Procedure Edits" section and access the most recent Practitioner PTP (Procedure-to-Procedure) edits.
3. *Downloading and Extracting the Edits:*
- The video explains how to download the ZIP file containing the NCCI edits and extract the database for use.
4. *Interpreting NCCI Edits:*
- Tony explains the meaning of different indicators in the NCCI edits:
- A "0" indicates that the procedure pair is not allowed to be billed together.
- A "1" indicates that the procedure pair is allowed with the application of the 59 modifier.
- A "9" indicates not applicable.
- He shows how to use the database to find specific codes relevant to therapy services by using examples like 97140 (manual therapy) and its interactions with other codes.
5. *Practical Examples:*
- The video includes detailed examples of common code pairs and their allowed billing combinations.
- For instance, manual therapy (97140) billed on the same day as massage therapy (97124) is not allowed, while manual therapy billed with a re-evaluation (97164) may require a 59 modifier.
6. *Additional Resources:*
- Tony promises to share the link to the source documents and provide a document summarizing the most common NCCI edits for Hippo Scribe users.
- He emphasizes the value of these resources in helping therapists stay compliant and efficient in their billing practices.
*Conclusion:*
The video concludes with Tony expressing his hope that the information provided is helpful. He encourages viewers to utilize the shared resources and document to better understand and apply NCCI edits in their practice.
🔗 Connect with Anthony Maritato
Website: www.choosept1st.com
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About Me:
Hi! My name is Tony Maritato, PT, and I am a physical therapist and practice owner. I created this channel, @LearnMedicareBilling, to help physical therapists, occupational therapists, and speech-language pathologists navigate the complexities of Medicare billing and reimbursement. My goal is to demystify the process and provide practical insights to help you succeed in your practice.
Over the years, I've expanded the channel to cover a wide range of topics related to private practice management and growth. From starting your own practice to optimizing your billing processes, you'll find valuable content designed to support your professional journey.
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Total Therapy Solutions
5900 Long Meadow Dr
Middletown, OH 45005
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