Billing for Therapy Functional Reporting Therapy G Codes PT OT SLP

We saw this change Effective January 1, 2013 – The Therapy Functional Reporting Therapy G Codes

The Policy: Therapy Functional Reporting Therapy G Codes

 

WHY the Change?

 

Section 3005(g) of MCTRJCA says, “The Secretary of Health and Human Services shall implement, beginning on January 1, 2013, a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)). Such strategy shall 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 and outcomes. This claims-based data collection system is being implemented to include both the reporting of data by therapy providers and practitioners furnishing therapy services and the collection of data by the contractors. This reporting and collection system requires selected claims for therapy services to include nonpayable G-codes and related modifiers. These nonpayable G-codes and severity/complexity modifiers provide information about the beneficiary’s functional status at the outset of the therapy episode of care, at specified points during treatment, and at the time of discharge. These G-codes and related modifiers are required on selected claims for all outpatient therapy services – not just those over the therapy caps. Source: CR-8005 Claims-Based Data Collection Requirement for Outpatient Therapy

The Therapy Functional Reporting Therapy G Codes for CY 2013 and the Severity/Complexity Modifiers

 

Mobility: Walking & Moving Around

 

Therapy Functional Reporting G Codes are: G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting

Determine the Appropriate severity/complexity modifier:

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

Changing & Maintaining Body Position

 

 

Therapy Functional Reporting Therapy G Codes are:

G8981 Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals G8982 Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8983 Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting

Determine the Appropriate severity/complexity modifier:

* With the Therapy Functional Reporting Therapy G Codes, append the appropriate modifier from shown below:

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

Carrying, Moving & Handling Objects

Therapy Functional Reporting Therapy G Codes are:

G8984 Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
G8985 Carrying, moving & handling objects functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8986 Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting.

Determine the Appropriate severity/complexity modifier:

* With the Therapy Functional Reporting Therapy G Codes, append the appropriate modifier from shown below:

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

Self Care

Therapy Functional Reporting Therapy G Codes are:

G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals
G8988 Self care functional limitation, projected goal status, at therapyepisode outset, at reporting intervals, and at discharge or to end reporting
G8989 Self care functional limitation, discharge status, at discharge from therapy or to end reporting

Determine the Appropriate severity/complexity modifier:

* With the Therapy Functional Reporting Therapy G Codes, append the appropriate modifier from shown below:

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

Other PT/OT Primary Functional Limitation

Therapy Functional Reporting Therapy G Codes are:

G8990 Other physical or occupational primary functional limitation, current status, at therapy episode outset and at reporting intervals
G8991 Other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8992 Other physical or occupational primary functional limitation, discharge status, at discharge from therapy or to end reporting

Determine the Appropriate severity/complexity modifier:

* With the Therapy Functional Reporting Therapy G Codes, append the appropriate modifier from shown below:

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

Other PT/ OT Subsequent Functional Limitation

Therapy Functional Reporting Therapy Therapy G Codes are:

G8993 Other physical or occupational subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
G8994 Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8995 Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reporting

Determine the Appropriate severity/complexity modifier:

* With the Therapy Functional Reporting Therapy G Codes, append the appropriate modifier from shown below:

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

Your Functional Limitation Reporting should be performed as follows:

1. Date of Initial Evaluation
2. At least every 10th Visit
3. Date of Re-evaluation
4. Discharge Date of Service
5. When further therapy treatment is necessary
6. When a new or different functional began under the same episode of care

Take note that the Therapy Functional Reporting Therapy G Codes and Severity Modifiers are non-reimbursable codes.

For Example:

Initial Evaluation for Physical Therapy Service

This is how you will code and submit/report the claim:

97001       GP                 $49.00
97110       GP                  $38.00
97140      GP                  $32.00
G8978    GP   CM         $00.00
G8979    GP  CI            $00.00
G8427                           $00.00
G8730                          $00.00
G8539                         $00.00

** Take note that the G8427, G8730 and G8539 are for PQRS if required.

Note: The KX modifier is not required on the claim line for nonpayable G-codes, but would be required with the procedure code for medically necessary therapy services furnished once the beneficiary’s annual cap has been reached.

Read more about this new guideline and reporting of functional limitation to Medicare! READ HERE

See attached PDF file downloaded from CMS

Read More CMS Guideline on Billing for Therapy Functional Reporting Therapy G Codes

220 – Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance

CMS-Manual-System-Pub-100-04-Medicare-Claims-Processing- Transmittal 2622

SUMMARY OF CHANGES:  Therapy Functional Reporting Therapy G Codes

This Change Request implements the MCTRJCA claims-based data collection requirement for outpatient therapy services by requiring the reporting of 42 new nonpayable therapy Functional Reporting Therapy G Codes and 7 new modifiers on claims for physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services.

Chapter 15 Medicare Benefit Policy Manual Covered Medical and Other Health Services Rev. 194 – 09-03-2014

EFFECTIVE DATE: January 01, 2013

Researched Keyword: therapy functional reporting therapy g codes

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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