Vol 3 2019 CEU Article, Breaking The Code: Seating And Wheeled Mobility Service Delivery Codes


Author Barbara Crume, PT, ATP
.1 CEU



Provision of therapy services to provide excellent care is billed using Current Procedural Terminology (CPT ®) Codes. These codes fit together like a puzzle and you have to know the codes and how they work together to “break the code” and successfully receive reimbursement. Your documentation must support the skilled services provided for each code. Every time you think you figured out how to use CPT® Codes for billing therapy for seating and wheeled mobility (SWM) services, a component changes. A code is eliminated or a new one added, a description changes, a Local Coverage Determination (LCD) changes or an insurance company decides not to cover that code. Correct coding for therapy services is critical to the success of any outpatient SWM clinic.

Learning Outcomes:
1. The participant will name 3 policies that affect reimbursement for therapy services.
2. The participant will name the 4 components of complexity and severity and select an appropriate evaluation code.
3. The participant will be able to name and describe 3 commonly used CPT Codes for SWM services and combinations that require the use of Modifier 59.

Barbara Crume, PT, ATP, earned her bachelor’s degree in Physical Therapy from the Medical University of South Carolina in 1982, became Pediatric NDT Certified in 1988 and RESNA Certified as an Assistive Technology Professional in 1997. She has been employed with CarePartners Health Services in Asheville, NC for almost 34 years. Barbara provides evaluations, fittings and training for clients of all ages and diagnoses to obtain manual and power wheelchairs with custom seating. She works closely with a variety of suppliers and consults with manufacturers on product development. She has presented courses on CPT® Coding and Reimbursement at the International Seating Symposium, RESNA Annual Conferences and as a Webinar for NRRTS and RESNA. She is an active participant in the Coalition to Modernize Medicare Coverage of Mobility Products and the Clinician Task Force.