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.

Which G-Codes should I use?

Here are the 42 new G-codes you can use to describe your patients’ primary functional limitation:

Mobility: Walking & Moving Around

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

Changing & Maintaining Body Position

  • G8981 Changing and maintaining body position functional limitation, current status, at therapy episode outset, and at reporting intervals
    • Short descriptor: Body pos current status
  • G8982 Changing and maintaining body position functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
    • Short descriptor: Body pos goal status
  • G8983 Changing and maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Body pos discharge status

Carrying, Moving & Handling Objects

  • G8984 Carrying, moving, and handling objects functional limitation, current status, at therapy episode and at reporting intervals
    • Short descriptor: Carry current status
  • G8985 Carrying, moving, and handling objects functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
    • Short descriptor: Carry goal status
  • G8986 Carrying, moving, and handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Carry discharge status

Self Care

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

Other PT/OT Primary Functional Limitation

  • G8990 Other physical or occupational primary functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Other PT/OT current status
  • 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
    • Short descriptor: Other PT/OT goal status
  • G8992 Other physical or occupational primary functional limitation, discharge status, at discharge from therapy to end reporting
    • Short descriptor: Other PT/OT discharge status

Other PT/OT Subsequent Functional Limitation

  • G8993 Other physical or occupation subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Sub PT/OT current status
  • G8994 Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Sub PT/OT goal status
  • G8995 Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Sub PT/OT discharge status

Swallowing

  • G8996 Swallowing functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Swallow current status
  • G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Swallow goal status
  • G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Swallow discharge status

Motor Speech

  • G8999 Motor speech functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Motor speech current status
  • G9186 Motor speech functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Motor speech goal status
  • G9158 Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Motor speech discharge status

Spoken Language Comprehension

  • G9159 Spoken language comprehension functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Spoken language comprehension current status
  • G9160 Spoken language comprehension functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Spoken language comprehension goal status
  • G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Spoken language comprehension discharge status

Spoken Language Expression

  • G9162 Spoken language expression functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Spoken language expression current status
  • G9163 Spoken language expression functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Spoken language expression goal status
  • G9164 Spoken language expression functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Spoken language expression discharge status

Attention

  • G9165 Attention functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Attention current status
  • G9166 Attention functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Attention  goal status
  • G9167 Attention functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Attention discharge status

Memory

  • G9168 Memory functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Memory current status
  • G9169 Memory functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Memory goal status
  • G9170 Memory functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Memory discharge status

Voice

  • G9171 Voice functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Voice current status
  • G9172 Voice functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Voice goal status
  • G9173 Voice functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Voice discharge status

Other Speech Language Pathology

  • G9174 Other speech language pathology functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Other speech language pathology current status
  • G9175 Other speech language pathology functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Other speech language pathology goal status
  • G9176 Other speech language pathology functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Other speech language pathology discharge status

What are the Severity Modifiers?

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.

 

2013 Functional Limitation Severity Modifiers

Modifier

Impairment Limitation Restriction

CH

0% impaired, limited, or restricted

CI

At least 1% but less than 20% impaired, limited, or restricted

CJ

At least 20% but less than 40% impaired, limited, or restricted

CK

At least 40% but less than 60% impaired, limited, or restricted

CL

At least 60% but less than 80% impaired, limited, or restricted

CM

At least 80% but less than 100% impaired, limited, or restricted

CN

100% impaired, limited, or restricted

 

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.

Want more info? Check out our free functional limitation webinar here.

New Year, New Codes: How to Bill for PT and OT Evaluations in 2017 - Regular BannerNew Year, New Codes: How to Bill for PT and OT Evaluations in 2017 - Small Banner
  • Common Questions from our G-Code Denials Webinar: Part 1 Image

    articleJul 29, 2014 | 6 min. read

    Common Questions from our G-Code Denials Webinar: Part 1

    Today’s blog post comes from WebPT writers Brooke Andrus and Erica Cohen. If a patient has more than one functional limitation associated with a single diagnosis, should I report G-codes and severity modifiers for all of them? No. Medicare will only accept functional limitation reporting (FLR) data for one primary functional limitation per case. Therefore, if the patient has multiple functional limitations associated with a single diagnosis, you'll need to determine which one represents the patient's primary …

  • The Basics of Functional Limitation Reporting Image

    articleMay 2, 2013 | 3 min. read

    The Basics of Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on Medicare part B patients in order to receive reimbursement for your services. While WebPT can monumentally help with this task through our soon-to-be-released integrated functional limitation reporting feature, it’s important that you still understand FLR thoroughly, especially because clinical judgment does play a large role in its completion. So, with that in mind, let’s tackle the basics of FLR. Why functional limitation …

  • webinarMay 21, 2013

    Get Ready for Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare patients in order to receive reimbursement for your services. We know you want to get paid. That’s why it’s crucial you have functional limitation reporting down pat. With that in mind, WebPT will host a special webinar on May 20 to help you get fully prepared for FLR. In this 60-minute session, hosts Heidi Jannenga and Mike Manheimer will explain …

  • Common Questions from our G-Code Denials Webinar: Part 2 Image

    articleJul 30, 2014 | 4 min. read

    Common Questions from our G-Code Denials Webinar: Part 2

    I heard that some private insurance carriers are now requiring functional limitation reporting. Is this true? Some non-Medicare insurers do require functional limitation reporting (e.g., Texas Workers' Compensation). Check out this blog post to see a list of the ones we know about right now. Keep in mind, however, that this list is ever-changing—so if you’re unsure of whether a particular plan requires FLR, be sure to inquire directly with the carrier. If I did not submit …

  • How to Complete Functional Limitation Reporting in WebPT Image

    articleFeb 19, 2014 | 4 min. read

    How to Complete Functional Limitation Reporting in WebPT

    As of July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) requires that therapists complete functional limitation reporting (FLR)—through the use of  G-codes and severity modifiers —on all eligible Medicare Part B patients at the initial evaluation, re-evaluation if applicable, every progress note (minimum of every ten visits), and discharge in order to receive reimbursement for their services. Today, several other private insurance companies also require FLR data as a condition of reimbursement. Good thing …

  • Functional Limitation Reporting Refresher Image

    articleDec 12, 2016 | 4 min. read

    Functional Limitation Reporting Refresher

    The rehab therapy industry is abuzz with PQRS talk right now. In case you missed it: PQRS as it exists today is dunzo . In 2017, it’ll be replaced with the Merit-Based Incentive Payment System , or MIPS. Unfortunately, though—and yes, it is unfortunate —PTs, OTs, and SLPs are not required to complete MIPS reporting until 2019. (And the jury is still out as to whether they’ll be able to voluntarily participate before then.) All outpatient rehab …

  • Functional Outcome Measures Image

    articleNov 28, 2012 | 5 min. read

    Functional Outcome Measures

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny …

  • articleMay 23, 2013 | 4 min. read

    Gaming the System and Other FLR No-Nos

    We all know that functional limitation reporting (FLR)  means (a little) more work for (basically) the same reward. And that can be a hard pill to swallow for many therapists who are already stretched thin as a result of increasing caseloads and increasingly stringent documentation requirements. Even so, taking the easy road—the low road—and gaming the system—and thus, this profession—is not the answer. It never is. This—just like everything else you do for your patients, your practice, …

  • articleJun 27, 2013 | 6 min. read

    Functional Limitation Reporting and You: What You Need to Know

    Wow, can July 1 really be right around the corner? Seems like yesterday we were only finding out about the requirement to document and report functional limitation G-codes and severity/complexity modifiers, and I think it really was only yesterday that CMS figured out how they would work. Let me start by making sure you understand that functional limitation reporting (FLR) and PQRS are separate and distinct programs and that each program has its own set of codes …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.