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Identifying Coding and Billing Red Flags

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, CFPS

November 15, 2024

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Question

What are some common coding and billing red flags in physical therapy?

Answer

Common coding and billing red flags in physical therapy include discrepancies between documented services and billed codes, billing for more units than time spent with the patient, and lack of medical necessity or skilled intervention in the documentation. Other red flags include billing for services that do not match the patient's documented needs, inconsistent use of CPT codes, and duplicate services billed by different therapists. To avoid these issues, therapists should ensure their documentation accurately reflects the services provided, supports the necessity and skill level of the interventions, and aligns with the billed codes. Regular audits and peer reviews can help identify and correct potential issues before they lead to denied claims or audits​​.

This Ask the Expert is an edited excerpt from the course, 'Medicare Part B Coding and Billing: Compliance is Key!', presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, CFPS.


kathleen d weissberg

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, CFPS

In her 30+ years of practice, Dr. Kathleen Weissberg has worked in rehabilitation and long-term care as an executive, researcher, and educator.  She has established numerous programs in nursing facilities; authored peer-reviewed publications on topics such as low vision, dementia quality care, and wellness; and has spoken at national and international conferences. She provides continuing education support to over 40,000 individuals nationwide as National Director of Education for Select Rehabilitation. She is a Certified Dementia Care Practitioner, a Certified Montessori Dementia Care Practitioner, and a Certified Fall Prevention Specialist.  She serves as the Region 1 Director for the American Occupational Therapy Association Political Action Committee and adjunct professor at Gannon University in Erie, PA. 


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