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
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.
EFFECTIVE DATE: January 01, 2013
Researched Keyword: therapy functional reporting therapy g codes
