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Physical Therapy Articles and Resources

Physical Therapy Articles

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Medical ID Theft

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Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

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The OIG Work Plan: What Is It and Why Should I Care?

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The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

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Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain

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Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.

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Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?

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Question:  It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...

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5 Ways to Minimize HIPAA Liabilities

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Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

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Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

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Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...

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Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?

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Question Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3. Also, it shows the ...

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RT and LT Modifier Usage Change (effective 2019-03-01)

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According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...

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Electrical Stimulation and Electromagnetic Therapy Devices

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Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.

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Podiatrist Billing for Physical Therapy

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It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ...

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Physical Therapy Caps Q/A

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Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...

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CPT Modifiers 96 & 97 for Habilitative and Rehabilitative Services (2018-01-01)

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Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. There have been questions on whether modifier 96 will be preferred over HCPCS modifier SZ, which describes the same types of habilitative (but not rehabilitative) services, but payers have not yet indicated which modifier ...

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Billing Exercise Equipment

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While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...

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Muscle Testing and Range of Motion Information

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Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.

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Wolters Kluwer Drug Pricing

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Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...

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Pelvic Floor Dysfunction Treatment Coverage

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Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings. Coverage by payers ...

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Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?

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Question: We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...

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Q/A: Can I Bill Mechanical Massage?

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Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.

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Q/A: Can I Bill Spinal Decompression Table to Insurance?

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Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?

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Q/A: Should I Bill Massage as 97124 or 97140?

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Question The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...

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Q/A: Can a PT Assistant Perform Physical Therapy Modalities?

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Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.

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Coding for Strains in ICD 10

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According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....

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When is 97112 Neuromuscular Re-education Billable?

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Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.

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Documentation for Home Health Services (Part A non DRG)

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The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

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Documentation and Orders for Respiratory Assistive Device

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The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.

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Documentation for Inpatient Rehabilitation Facilities

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The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).

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Increased Therapy Denials Create Administrative Burden

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Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...

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CPT Modifers 96 & 97 for Habilitative and Rehabilitative Services

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Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. CMS has added modifiers 96 and 97 to their edits (see MLN Matters MM10385 here) and modifier SZ is deleted as of December 31, 2017. Private payers should simply adjust their policies to use ...

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Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes

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According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...

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Insufficient Documentation Errors

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According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation  submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary. Claims ...

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Medicare Requiring Specific Modifiers on Therapy Services

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Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following: Services furnished under the Outpatient ...

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Billing with a GP Modifier

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Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?

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Should ROM Testing be Reported with Evaluation and Management Services?

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Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.

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Outpatient Rehabilitation Modifiers

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Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries. For services delivered under an outpatient plan of care use modifier: GN for speech-language pathology GO for occupational therapy GP for physical therapy In addition to using the correct modifier, ...

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Beware of Limitations When Using Electrical Stimulation - Ultrasound

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Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue.  This is done by applying sound waves to produce heat and/or vibration.  Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ...

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Reimbursement for Therapy Students

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According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ...

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Proper Usage of Electrical Stimulation

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According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment. 97032 is a constant attendance electrical stimulation modality ...

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Skilled Therapy, When it's Appropriate and Billable

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According to CGS Administrators, "A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...

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Initial Evaluation Codes for PT's and OT's

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According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation. These evaluation codes are untimed, billable as one unit. Do ...

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PT and OT Reevaluation Coding

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According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...

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General Physical Therapy Modality Guidelines

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According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention. CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...

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Diathermy eg Microwave Use and Documentation

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According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...

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Ultrasound Therapy

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According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...

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Hydrotherapy Guidelines

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According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...

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Physical Therapist can now bill for a substitute Physical Therapist

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As of 6/13/2017 Medicare contractors shall accept claims from Physical Therapists, Provider Specialty 65 – Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier. The A/B MAC Part B may pay the patient’s regular physician for physicians' ...

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Billing Negative Pressure Wound Therapy (NPWT) (disposable device)

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Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes: 97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...

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Mechanical Traction Therapy

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According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...

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Physical Therapy Webinars

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E/M and the Organ Systems Part 2 of 2

E/M and the Organ Systems Part 2 of 2

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Joints: Rotator Cuff, Elbow, Wrist, and Hand

In this webinar, Brandon will review the bones and major joints of the upper extremities (arm, forearm, wrist, hand, and digits), as well as their supporting structures and how they are affected by injury, disease, and other conditions.

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All About Knee Coding & Auditing

Total knee replacement now acceptable ASC procedure also, not auditing for a year. Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers.

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Anatomy of the Knee

Coders and billers in orthopedic practices must understand the knee extensively. Join Dee to master the anatomy of the knee joint, and understand how it applies to ICD-10-CM diagnosis coding.

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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How to Check NCCI Edits Using FindACode

How to Check NCCI Edits Using FindACode

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ICD-10-CM Training - Session 08

ICD-10-CM Training - Session 08

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ICD-10-CM Training - Session 07

ICD-10-CM Training - Session 07

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ICD-10-CM Training - Session 06

ICD-10-CM Training - Session 06

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ICD-10-CM Training - Session 05

ICD-10-CM Training - Session 05

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ICD-10-CM Training - Session 36

ICD-10-CM Training - Session 36

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ICD-10-CM Training - Session 35

ICD-10-CM Training - Session 35

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ICD-10-CM Training - Session 34

ICD-10-CM Training - Session 34

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ICD-10-CM Training - Session 33

ICD-10-CM Training - Session 33

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ICD-10-CM Training - Session 04

ICD-10-CM Training - Session 04

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ICD-10-CM Training - Session 32

ICD-10-CM Training - Session 32

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ICD-10-CM Training - Session 31

ICD-10-CM Training - Session 31

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ICD-10-CM Training - Session 03

ICD-10-CM Training - Session 03

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ICD-10-CM Training - Session 02

ICD-10-CM Training - Session 02

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ICD-10-CM Training - Session 30

ICD-10-CM Training - Session 30

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ICD-10-CM Training - Session 29

ICD-10-CM Training - Session 29

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ICD-10-CM Training - Session 28

ICD-10-CM Training - Session 28

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ICD-10-CM Training - Session 27

ICD-10-CM Training - Session 27

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ICD-10-CM Training - Session 01

ICD-10-CM Training - Session 01

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ICD-10-CM Training - Session 26

ICD-10-CM Training - Session 26

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ICD-10-CM Training - Session 25

ICD-10-CM Training - Session 25

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ICD-10-CM Training - Session 24

ICD-10-CM Training - Session 24

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ICD-10-CM Training - Session 23

ICD-10-CM Training - Session 23

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ICD-10-CM Training - Session 22

ICD-10-CM Training - Session 22

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ICD-10-CM Training - Session 21

ICD-10-CM Training - Session 21

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ICD-10-CM Training - Session 20

ICD-10-CM Training - Session 20

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ICD-10-CM Training - Session 19

ICD-10-CM Training - Session 19

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ICD-10-CM Training - Session 18

ICD-10-CM Training - Session 18

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ICD-10-CM Training - Session 17

ICD-10-CM Training - Session 17

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ICD-10-CM Training - Session 16

ICD-10-CM Training - Session 16

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ICD-10-CM Training - Session 15

ICD-10-CM Training - Session 15

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ICD-10-CM Training - Session 14

ICD-10-CM Training - Session 14

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ICD-10-CM Training - Session 13

ICD-10-CM Training - Session 13

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ICD-10-CM Training - Session 12

ICD-10-CM Training - Session 12

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ICD-10-CM Training - Session 11

ICD-10-CM Training - Session 11

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ICD-10-CM Training - Session 10

ICD-10-CM Training - Session 10

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ICD-10-CM Training - Session 09

ICD-10-CM Training - Session 09

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Physical Therapy Resources

  • Reimbursement Guide (Deskbook)
  • ICD-10-CM Specialty Specific Code Book
  • Provider Documentation Guides
  • ICD-10-CM Comprehensive Code Books
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