Functional Limitation G-Codes ... Are You Ready?

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New Functional Limitation G-Codes

Beginning on January 1, 2013 in a testing phase and required as of July 1, 2013, therapists are required to report new G-Codes to report the functional limitation of their patients. This new set of G-Codes will move therapists closer to incorporating function and functional progress with treatments. The new  G-Codes must be reported at the initial evaluation, the 10-visit mark, and at discharge. There are a total of 42 new non-payable G-Codes and 7 new modifiers for use on claims for Physical Therapy, Occupational Therapy, and Speech-Language Pathology services. More information is available in the MLN Matters MM8005 transmittal from the Department of Health and Human Services.

 

Why do we need Functional Limitation G-Codes?

The Middle Class Tax Relief and Jobs Creation Act of 2012 directed the Secretary of Health and Human Services to implement a claims-based collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services. The strategy should be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition outcomes.

The functional limitation G-Codes are effective for therapy services beginning on January 1, 2013. However, a testing period will be in effect from January 1, 2013 until June 30, 2013 to allow providers to use the new coding requirements and to assure that their systems work. Beginning July 1, 2013, Medicare will begin returning and rejecting claims for therapy services that do not contain the required functional G-Code information.

 

What are the Functional Limitation G-Codes?

Below are some of the functional limitation G-Codes that are to be used by Physical Therapists. They are organized in related sets. This is not a complete list and is subject to change.

 Mobility Set

  • G8978 -Mobility: walking and moving around functional limitation, current status, at episode outset and reporting intervals
  • G8979 – Mobility: walking and moving around functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8980 – Mobility: walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting

Changing and Maintaining Body Position Set

  • G8981 – Changing and Maintaining Body Position functional limitation, current status, at episode outset and at reporting intervals
  • G8982 - Changing and Maintaining Body Position functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8983 - Changing and Maintaining Body Position functional limitation, discharge status, at discharge or to end reporting

Carrying, Moving and Handling Objects Set

  • G8984 – Carrying, Moving and Handling Objects functional limitation, current status, at episode outset and at reporting intervals
  • G8985 – Carrying, Moving and Handling Objects functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8986 – Carrying, Moving and Handling Objects functional limitation, discharge status, at discharge or to end reporting.

 Self Care Set

  • G8987 – Self Care functional limitation, current status, at episode outset and at reporting intervals
  • G8988 – Self Care functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8989 – Self Care functional limitation, discharge status, at discharge or to end reporting.

Other PT/OT Primary Set

  • G8990 – Other PT/OT Primary functional limitation, current status, at episode outset and at reporting intervals
  • G8991 – Other PT/OT Primary functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8992 – Other PT/OT Primary functional limitation, discharge status, at discharge or to end reporting.

 Other PT/OT Subsequent Set

  • G8993 – Other PT/OT Subsequent functional limitation, current status, at episode outset and at reporting intervals
  • G8994 - Other PT/OT Subsequent functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
  • G8995 - Other PT/OT Subsequent functional limitation, discharge status, at discharge or to end reporting.

 

Severity/Complexity Modifiers

For each non-payable G-Code used, a modifier must be used to report the severity/complexity for that functional measure. The severity modifiers reflect the patient’s percentage of functional impairment as determined by the therapist furnishing the therapy services. The seven modifiers include:.

  • CH – 0 percent impaired, limited or restricted
  • CI – At least 1 percent but less than 20 percent impaired, limited, or restricted
  • CJ – At least 20 percent but less than 40 percent impaired, limited, or restricted
  • CK – At least 40 percent but less than 60 percent impaired, limited, or restricted
  • CL – At least 60 percent but less than 80 percent impaired, limited, or restricted
  • CM – At least 80 percent but less than 100 percent impaired, limited, or restricted
  • CN – 100 percent impaired, limited, or restricted

Required Reporting of Functional G-Codes and Severity Modifiers

The functional G-Codes and corresponding severity modifiers are used in the required reporting on specified therapy claims for certain Dates of Service. Only one functional limitation shall be reported at a given time for each related therapy plan of care. Functional reporting is required on therapy claims as shown below:
  • At the outset of a therapy episode of care (on the Date of Service of the initial therapy service).
  • At least once every 10 treatment days.
  • The same Date of Service that an evaluative procedure is submitted (Codes 97001, 97002, 97003, 94004)
  • At the time of discharge from the therapy episode of care
  • On the same Date of  Service the reporting of a particular limitation is ended, in cases where the need for further therapy is needed
 Don’t forget to contact your billing service or billing software vendor to ensure they can properly process the functional limitation G-Codes before they go into effect next year.
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