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2019 NCCI Edits and Changes to Appending Modifier 59
Hosted By: Gawenda Seminars & Consulting, Inc.
Location: Webinar
Ypsilanti, MI
Start Time: 6/19/2019 1:00 PM
End Time: 6/19/2019 2:30 PM
Time Zone: Eastern

If you have questions about registration or logistics for this webinar conference, click the grey "Event Contact Information" button above for contact information for the webinar conference manager. If you have content or other questions specifically for Rick Gawenda, please contact him through his website:

2019 NCCI Edits and Changes to Appending Modifier 59

Wednesday, June 19, 2019
(time varies depending upon your location)

• 10:00 am - 11:30 am Pacific Daylight Time
• 11:00 am - 12:30 pm Mountain Daylight Time
• 12:00 pm – 1:30 pm Central Daylight Time
• 1:00 pm – 2:30 pm Eastern Daylight Time

One registration allows for one computer log on and/or one phone line in which you can have as many participants sit and listen via your computer speaker or speaker phone and all would be eligible to receive a course certificate that you could submit to your state for POSSIBLE CEU credit

Presenter: Rick Gawenda, PT

Early Registration Deadline: June 5, 2019 at 11:59PM EDT
Final Registration Deadline: June 19, 2019 at 11:30AM EDT

National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices in outpatient therapy as well as other services. NCCI edits were first implemented in 1996 by the Medicare program and applied only to private practices. In 2000, the Medicare program expanded NCCI edits to hospital outpatient departments and in 2006; NCCI edits were expanded to all other outpatient settings (i.e. skilled nursing facilities, CORF's rehabilitation agencies, and home health agencies providing Part B services) under the Medicare program.

Modifier 59 is used by outpatient therapy providers to bypass certain NCCI edits and allow the payment of more than 1 CPT code billed on the same day that an insurance carrier may consider should be bundled and separate payment should not be made. Because of this, modifier 59 is not only the most commonly used modifier, it is also the most commonly abused modifier. In addition, the need to use modifier 59 is not only within the same discipline but may also be required when a patient is receiving multiple disciplines from the same provider on the same date of service.

On July 1, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement version 25.2 of the NCCI edits and will change how modifier 59 is appended to the CPT code(s) on the claim form. This 1.5-hour webinar program will explain NCCI edits, the use of modifier 59 and what code(s) to append modifier 59 to on the claim form. In addition, the webinar will provide detailed and realistic examples when providers of outpatient therapy services would utilize modifier 59. Examples will include all 3 disciplines as well as how speech therapy billing impacts the physical and occupational therapy codes billed the same day. Lastly, participants will receive Gawenda Seminars & Consulting NCCI Version 25.2 “cheat sheet” to assist them in knowing when to apply modifier 59 to a CPT code on the claim form.


At the conclusion of this webinar presentation, participants will:

1. Describe and understand NCCI edits and the use of modifier-59 for outpatient
therapy services
2. Describe and understand column 1/column 2 NCCI edits and which CPT code(s)
requires modifier 59
3. Be able to use the NCCI edit “cheat sheet” to append modifier-59 to the correct CPT
code(s) on the claim form
4. Recite how one discipline’s billing may cause another discipline’s billing to
require modifier 59
5. Understand the documentation that must be present in the medical record to support the use of
modifier 59

Includes a live Question & Answer session at the end of the presentation.

Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. and Director of Finances for Kinetix Advanced Physical Therapy Inc., a private practice located in southern California. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website,, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.

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

Mr. Gawenda is also 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”.

Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.

In addition to the expertise and advice presented during this webinar conference, you'll also receive a handout (in PDF format) that will include related reference links as well as Gawenda Seminars & Consulting NCCI Edit Version 25.2 "Cheat Sheet" for use of modifier 59 in outpatient therapy.

Webinar recordings are NOT included with registration, but registrants have an option to purchase a webinar playback link for $49.95 (view via your computer as many times as you would like and audio comes through your computer speakers) or CD (audio only) for $69.95 prior to completing online registration or send in the additional fee with your registration and check.

Audio - phone connection required only to hear the audio portion of the webinar

Webinar - Computer and internet connection required. Participants will be provided a url link where they can log in and follow the presentation on their computer as the speaker provides the presentation. If your computer has speakers, you will be able to hear the audio portion through your computer speakers and will not require a phone connection. If no speakers on your computer or unable to be at a computer, participants will need to call in to the phone number provided to them to hear the audio portion. You will need adobe flash. Gawenda Seminars & Consulting, Inc is not responsible for organization fire walls or computer software issues that may interfere and/or prohibit your connection to the webinar portion of the presentation.

TelSpanWeb System Requirements to View Webinar:

Operating Systems:

• Windows XP, Windows Vista, Windows 7, Windows 8
• MAC OS X v10.4 or Higher
• Linux
• Solaris

Internet Browsers:

• Internet Explorer 7 or Higher (Windows)
• Firefox 4 or Higher
• Safari 4 or Higher
• Google Chrome 2 or Higher

Stable Internet Connection, DSL or Above:

• 100 kbps for Video Transmission
• 300kbps for Screen Sharing and Remote Control
• Recommended 500kbps to ensure fluidity of all Services

Flash Player 10.3 or Newer:

Disabled pop-up blockers

Computer speakers for participants listening over the computer

In order to ensure successful connection to your upcoming meeting, please take a moment to conduct a system test by copying and pasting the entire url link in your web browser:

This webinar has not been submitted to any state board or national organization for CEU approval. A certificate of attendance will be available upon completion of the webinar for each participant and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this webinar conference.

Register for the event on or before 11:30am EDT on June 19, 2019.

When you register, you'll receive a confirmation e-mail that serves as your receipt . Approximately 5 days before the webinar conference, you will receive a separate email that provides you with instructions for accessing the call and handouts. If you register within 5 days of June 19, 2019, instructions will be emailed the evening of the day you registered (after 6:00PM pacific time). Please make sure that your email system will accept messages from the webinar conference host: The easiest way to do this is to add this email address to the contacts list in your email software.

Gather your staff and listen to this webinar conference via your computer speakers or a speaker phone, follow along with the session handout on your computer, and participate in a live, interactive Question and Answer session.

Event Deadlines / Fees:
The early deadline for registration for this webinar conference is 11:59pm EDT, June 5, 2019. Final registration for the webinar conference is 11:30am EDT on June 19, 2019. Please call Michelle at 661.350.6187 if you would like to register after the deadline.
Registrant Type Deadline Name Deadline Date Fee
New Early Registration 6/5/2019 $79.00
New Late Registration 6/18/2019 $99.00
This webinar has been completed. If you missed the webinar, but still need the material, why not purchase the Playback Link.

The Playback Link is the actual webinar recorded in its entirety and includes the question and answer time at the end. The Playback Link comes with the handouts in a pdf format and includes Gawenda Seminars & Consulting NCCI Reference Sheet.

To order the Playback Link, go to
Additional Information:
Type Document Title
Printable Registration Form
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