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Today's blog post comes from WebPT Senior Copywriters Erica Cohen and Charlotte Bohnett.

Like the 90s hip-hop-themed title of this blog post implies, G-codes may be new, but they’re nothing to fret over. Essentially, effective July 1, 2013, CMS will require therapists to report new G-codes, moving us closer to incorporating function and functional progress within our treatment. But the good news is that you should already be checking (and documenting) functional progress through your short- and long-term goal updates at the intial evaluation, 10-visit mark minimum, and at discharge; now it’s really just about linking a G-code with that progress.

So, what exactly is a G-code? And what are the new ones?
G-codes are a way for CMS to collect information on their beneficiaries’ function and condition on claims forms. According to the APTA’s Highlights of the 2013 Physician Fee Schedule Final Rule, “by collecting data on beneficiary function over an episode of therapy services, CMS hopes to better understand the beneficiary population that uses therapy services and how their functional limitations change as a result of therapy services.” While CMS does not plan to use this information to change coverage policies, it will assist in outpatient therapy services payment reform.

Here are just a few of the 42 new G-codes you can choose from to describe your patient’s functional limitation that is the primary reason for the therapy services:

Mobility: Walking & Moving Around

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

Changing & Maintaining Body Position

  • G8981 Changing and maintaining body position functional limitation, current status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting.
  • G8983 Changing and maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals.

Self Care

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

Other PT/OT Primary Functional Limitation

  • 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.

Other PT/OT Subsequent Functional Limitation

  • G8993 Other physical or occupation 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, at at discharge or to end reporting.

Swallowing

  • G8996 Swallowing functional limitation, current status, at time of initial therapy treatment/episode outset and reporting intervals.
  • G8998 Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation

Other categories include motor speech, spoken language comprehension and expression, attention, memory, voice, and other SLP functional limitation.

How do you as a PT, OT, or SLP use them?
With each G-code, use one of the following modifiers (in a seven point scale) to report the severity and complexity for that functional limitation. You base this assessment on the score of an outcome measurement tool as well as your skilled clinical knowledge as a therapist.
In addition to reporting these new G-codes and modifiers, you must also include the therapy modifiers (GO, GP, and GN) to indicate that the therapy services are furnished under an OT, PT, or SLP plan of care, respectively.

Table 23

All PTs, OTs, and SLPs will need to include G-codes on their claims forms. According to the APTA, under this new rule, you should include non-payable G-codes and modifiers on the claims forms that capture data about the beneficiary’s functional limitations (a) at the first session; (b) at a minimum every 10th visit; and (c) at discharge. Additionally, report your projected goal for functional status at the end of treatment on the first claim for services and at the end of the episode. Modifiers will indicate the extent of the severity/complexity of the functional limitation. If you do not expect your patient to improve as a result of a degenerative disease, for example, or expect limited improvement, use the same modifier for the current status and projected goal status.

When are they effective?
As stated above, you’ll be required to report these G-codes July 1, 2013. However, WebPT will make them available within the application in mid-spring. You may be thinking: if they aren’t mandatory until July 1st, why bother with ‘em before then? Well, practice makes perfect, and you might as well get acclimated to the new codes before they become mandatory to report.

Anything else I need to know?

  1. If your patient’s functional limitation does not fit into one of the predefined categories, you can use the “other” category.
  2. According to the APTA, if you use tools like FOTO, you can report composite functional scores by using G8990, G8991, and G8992. If the patient achieves their goal and there is a second condition, you should use the G-codes G8993-G8896 for “other subsequent” functional limitation.
  3. Don’t forget to contact your billing service or billing software vendor to ensure they can properly process the G-codes before they go into effect next year. 
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Charlotte Bohnett

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