functional limitation reporting Archives | WebPT

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Ain’t Nothin’ But a G-Code, Baby. What You Need to Know About the New G-Codes.

Like the ’90s hip-hop-themed title of this blog post implies, Functional Limitation Reporting G-codes may be new, but they’re nothing to fret over. Essentially, effective July 1, 2013, CMS began requiring therapists to report new G-codes in an effort to further emphasize function and functional progress in therapy treatment. But the good news is that you should already be assessing—and documenting—functional progress as part of your short- and long-term goal setting at the initial evaluation, tenth visit (at least), and discharge. Now, all you need to do is assign a G-code that reflects that progress.

What’s a G-Code?

CMS uses G-codes to collect information about its beneficiaries’ functional limitations via claim forms. As we wrote here, “CMS will use all of this information to better understand the beneficiary population that uses therapy services and how their functional limitations change as a result of the therapy they complete. Furthermore, CMS will use the data they collect to reform future payment structures.”

There are 42 codes.

There are 42 G-codes available to choose from to best describe your patient’s primary functional limitation (i.e., the main reason that patient sought out therapy services). Here are just a few:

Mobility: Walking and 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
  • G8980 Mobility: walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting
Changing and Maintaining Body Position
  • G8981 Changing and maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
  • 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
  • G8983 Changing and maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
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, and at discharge or to end reporting
  • G8989 Self care functional limitation, discharge status, at discharge from therapy 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
  • G8992  Other physical or occupational primary functional limitation, discharge status, at discharge from therapy 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, 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
Swallowing
  • G8996 Swallowing functional limitation, current status, at therapy episode outset and at reporting intervals
  • G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
  • G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting

Other categories include motor speech, spoken language comprehension and expression, attention, memory, voice, and other SLP functional limitation. If your patient’s functional limitation does not fit into one of the predefined categories, then you can use the “other” category. For a full list of the FLR G-codes, check out this blog post.

Download the Therapists’ Guide to FLR now.

Access full G-code lists, documentation instructions, and functional limitation reporting examples in our PDF handbook. Enter your email address below, and we’ll send it your way.

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The Complete PT Billing FAQ

Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.)

Questions related to:

• WebPT
• Modifier 59
• Other Modifiers
• Coding
• ICD-10
• Advance Beneficiary Notice (ABN) of Noncoverage
• Claims
• Contracts and Fee Schedules
• 8-Minute Rule
• Functional Limitation Reporting
• Cash-Pay Patients

WebPT

How does WebPT help me bill better?

WebPT prompts users to apply modifier 59.

When WebPT detects that you have billed two codes that form a CCI edit pair, the system will alert you and ask whether you performed these services separately and distinctly of one another—and, therefore, should receive payment for both. If you attest that this is the case, WebPT will automatically apply modifier 59 to the appropriate code.

For WebPT Members

To activate this feature, please follow the steps below. Note that you’ll need to complete these steps for each insurance plan. We recommend applying this to commercial and government plans only (i.e. no workman’s compensation, legal/lien, and auto liability policies).

  1. Select “Display Insurance,” located on the left side of the WebPT Dashboard.
  2. Click “Edit” on the individual insurance for which you want to activate the feature.
  3. Once the insurance editing screen opens, check “Apply CCI edits”; then, select “Save.”
For Non-WebPT Members

If you’re not yet a WebPT Member, you can see this functionality and an array of other awesome features in a free, live online demonstration. Request one here.

WebPT tracks the therapy cap.

WebPT offers the Medicare Cap Report, which enables you to view Medicare beneficiaries’ progress toward the therapy cap and see whether therapists have affixed the KX modifier for those patients who have, in fact, exceeded the cap. In addition to tracking the therapy cap, WebPT alerts providers when a patient is:

  • approaching the cap
  • exceeding the cap (time to attach the KX modifier!)
  • approaching the manual medical review threshold ($3,700)
  • exceeding the manual medical review threshold

To learn more about the Medicare Cap Report and WebPT’s other compliance reporting and tracking capabilities, check out this blog post.

WebPT calculates the 8-minute rule.

As this blog post explains, “WebPT automatically double-checks your work for you and alerts you if something doesn’t add up correctly. All you have to do is record the time you spend on each modality as you go through your normal documentation process, along with the number of units you wish to bill. If those two totals don’t jibe, WebPT will not only let you know something’s off, but we’ll also tell you whether you overbilled or underbilled. That way, you can quickly identify and fix the problem—and thus, ensure accurate payment. Plus, you’ll have a detailed record of the services you provided on each date of service—something many local MAC auditors request to substantiate billing claims and processes.”

WebPT handles PQRS reporting.

WebPT is a certified PQRS registry. This means we collect PQRS claims data and submit it to Medicare on your behalf. We also have all the PQRS reporting requirements in our system, so depending on the Medicare beneficiary and visit, we’ll prompt you to complete the appropriate measure. Learn more about PQRS with WebPT.

What diagnosis code flows over from WebPT into my billing?

When you use WebPT, your treatment diagnosis is the one that is billed—not the medical diagnosis.

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