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 functional limitation—in other words, the main reason the patient sought therapy.

If I’m already treating a patient for one diagnosis and the patient comes in with a prescription for a second, unrelated diagnosis, what should I do? Can I treat the patient—and successfully complete functional limitation reporting—for two different diagnoses at the same time?

Yes. The tricky part is that because Medicare can only accept functional limitation reporting data for one primary functional limitation at a time, you must either combine the diagnoses into one case (if that is clinically appropriate) or, if you decide to treat the diagnoses as separate cases, you must designate one of the cases as the "reporting case." This means you must discharge the "non-reporting case" as far as functional limitation reporting is concerned. If you decide that the patient's original case (case 1) still represents his or her primary functional limitation, you would complete functional limitation reporting for the second case (case 2) as a one-time visit (i.e., you would submit three sets of G-codes and severity modifiers for the patient’s current status, projected goal status, and discharge status). Alternatively, if you decide the second case actually represents the patient's primary functional limitation, you would submit the discharge data for case 1 on the initial evaluation for case 2. You would then begin functional limitation reporting for case 2 on the next date of service. For an example of this scenario, check out this Physiospot post by WebPT founder Heidi Jannenga.

In the scenario above, how would I indicate which case is the reporting case?

No additional designation to Medicare is necessary. Medicare will only accept one set of FLR codes per patient, per discipline. So whichever case you select for functional limitation reporting will, by default, become the reporting case.

So, if I combine two concurrent cases into one, I only need to continue functional limitation reporting for that single case?

Yes. In fact, if a patient presents with two diagnoses simultaneously, we recommend combining them into one if it is possible and it makes sense clinically. This allows for a much simpler, much more manageable reporting process. However, if you decide it is in the patient's best interest to treat the issues separately, follow the guidelines outlined in the answer above.

How should I complete functional limitation reporting if I’m treating a patient for two separate diagnoses on separate days?

In this scenario, you should designate one of the cases as the “reporting case.” That is the case that represents the patient’s actual primary functional limitation and the one for which you will report G-codes. Here’s an example:

Patient John is seeing PT Jane for back pain (case 1). His functional limitation is Mobility: Walking & Moving Around. A week later, John presents with a second diagnosis for knee pain (case 2). Jane wants to treat the patient for each diagnosis separately, on different days, so she creates two cases. On her initial evaluation for case 2, Jane decides that John’s primary functional limitation is actually Carrying, Moving & Handling Objects, so she reports discharge codes for John’s original primary limitation (Mobility: Walking & Moving Around). Then, on the next daily note, regardless of which case she’s treating, Jane will document the new functional limitation G-codes for Carrying, Moving & Handling Objects. The ten-visit count begins when she documents the new functional limitation reporting codes—and the count is shared between both cases. So Jane must make sure she completes a progress note with functional limitation reporting data on or before John’s tenth visit.

Alternatively, if Jane believes that John’s primary functional limitation is still the one he originally presented with (Mobility: Walking & Moving Around), she’ll report FLR for the second limitation (Carrying, Moving & Handling Objects) on the initial evaluation as if it were a one-time visit by submitting three sets of codes: current, goal, and discharge status G-codes along with corresponding severity modifiers for each. She’ll then continue to report FLR as normal for Mobility: Walking & Moving Around.

In both situations, Jane would weave elements of her treatment plan for the patient’s primary functional limitation into the other case to ensure that the patient is able to achieve the best possible results.

If a patient is receiving treatment for two different issues from two therapists in different disciplines (e.g., one PT and one OT), do both therapists need to complete functional limitation reporting?

In this scenario, each therapist would complete functional limitation reporting separately and independently of one another.

What if the patient is receiving treatment for two different issues from two therapists in the same discipline (e.g., two different PTs)?

If you’re already treating a patient for one issue and he or she presents with a second, unrelated diagnosis, and you believe that the patient would be better off receiving treatment for his or her new diagnosis from another physical therapist in your clinic, then the second therapist should open a separate case and begin therapy. In this scenario, both therapists should work together to determine which of the diagnoses represents the patient’s primary functional limitation. If you both decide the original diagnosis remains the primary functional limitation, you will continue to report functional limitation data as normal and the second therapist will complete FLR for the second limitation as if it were a one-time visit by submitting three sets of codes: current, goal, and discharge status G-codes along with corresponding severity modifiers for each.

If you both decide that the new diagnosis is the patient’s primary functional limitation, the therapist treating the new diagnosis will discharge the original limitation during the initial examination for the new diagnosis and record the current and projected goal statuses and the corresponding modifiers for the new primary limitation on the patient’s next visit. That therapist will then take over FLR for that patient. Because you’ll only submit FLR data for the patient’s primary functional limitation, both therapists should collaborate to ensure they are working toward the same functional limitation goal. For example, if the first therapist is addressing a mobility limitation, but both therapists agree that self-care is actually the patient’s primary limitation, then both therapists must incorporate treatment elements that will help the patient progress toward his or her self-care goals.

Read Part 2 here!

Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid - Regular BannerDown with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid - Small Banner
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