We’ve covered the ins and outs of G-codes as well as how it easy it will be to implement them successfully within WebPT—and why an integrated functional limitation reporting solution is the best solution. Today let’s go back to the G-code basics.

What’s a G-code?

Effective July 1, 2013, CMS will require therapists to complete functional limitation reporting through the use of new G-codes and corresponding severity modifiers for all eligible Medicare patients at the initial examination, at minimum every ten visit (or progress note), and at discharge in order to receive reimbursement.

Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L.

By now, I’m sure you’ve heard about functional limitation reporting—also known as claims-based outcome reporting (CBOR) and G-code reporting. Regardless of what your clinic calls it, functional limitation reporting is coming quickly. In fact, as of July 1, 2013, CMS is making it mandatory. That means they won’t pay you for your services if you don’t properly report functional limitations via specific G-codes on the claim form for each eligible Medicare patient. Now, if you’re a WebPT Member, we got you covered. In mid-spring, we’re integrating functional limitation reporting (G-codes and corresponding severity modifiers) into your documentation workflow, which will make it a breeze to stay compliant—and thus, get paid.

Last month we covered functional limitation reporting basics in several blog posts, a webinar, and an article on Physiospot, but in the midst of all this—and especially at CSM 2013—I’ve realized that in addition to understanding functional limitation reporting inside and out, we need to understand its importance beyond getting paid. While overall the transition to functional limitation reporting is a good thing, it may actually fall short in terms of bringing our profession closer to achieving evidence-based practice on the whole. Why, you ask?

The Good

Functional limitation reporting will allow us to gain tremendous insight into our patients’ and our peers’ patients’ functional outcomes. Just think of what all that data could show based on treatment type and patient demographics, and that goes for us as individual providers and for us as an industry. This is our chance to prove unequivocally that rehab therapy works—and to see which techniques work best. We’re clearly moving towards a pay-for-performance reimbursement structure, and this is an ideal way to demonstrate our patients’ progress with our care. Additionally, this reporting requirement will make us better therapists by insisting that we treat function and not just objective measures. 

The Opportunities

Because this requirement is more heavily focused on the subjective—what the patient thinks and feels—questions remain as to whether it may actually weaken our evidenced-based practice efforts. As an industry, we’ve fully researched and vetted many functional outcome measurement tools as reliable and valid tests. However, they are still based on the subjective complaints of the patient vs. objective measures taken by the therapist. Ultimately, it appears Medicare’s stance is that what the patient thinks and feels is what really matters—which in my opinion is accurate. But it doesn’t appear that Medicare really cares what method or treatment procedures we use to achieve patient improvement—just do it and do it as quickly as possible. This does not promote nor advocate for true evidence-based practice. It’s just by any means necessary.

Go Forward

In the end, though, we can’t let Medicare’s apathetic vibe influence our behavior and practice. While we need to understand and acknowledge the opportunities, it shouldn’t be what we focus on. Let’s hone in on the good. During CSM 2013, in the Autonomy presentation, an attendee stood up and said: “Functional Limitation Reporting is good. It might be more paperwork [which with WebPT, it won’t], but it’ll prove our worth.” That’s the attitude I’m embracing, and I think we all should. We encourage our patients to think positive—no matter how difficult the process or how murky the waters ahead might be. We need to encourage ourselves to do the same.