If an L-Code is the only code used on a patients first visit and then the patient returns for a follow-up visit where the patient receives treatment coded using “always therapy” or “sometimes therapy” codes, is a G-code required? If yes, which visit would the counting of “10 visits” begin?
Question – Posted July 3, 2018 If a patient has a commercial insurance as their primary insurance when they begin an episode of outpatient therapy and then switches to traditional Medicare Part B during the course of therapy, when would I first report G-codes on the claim form and in the medical record?
Question – Posted July 3, 2018 In 2018, when is functional limitation reporting (i.e. G-codes) required?
Question – Posted July 3, 2018 When is functional limitation reporting (i.e. G-codes) required?
Question – Posted May 24, 2017 A patient has two unrelated diagnosis for which they are seen by a PT for one, and OT for the other. Must both disciplines use just one set of g codes (i.e. self care or mobility) for both episodes of care, or can each discipline report a different set for each diagnosis?
Question – Posted September 7, 2016
If we saw a Medicare beneficiary for therapy services while they were in the emergency department or under observation status and they get discharged home without being admitted to the hospital, is functional limitation reporting required on the Medicare beneficiary?
Question – Posted March 6, 2015 If we saw a Medicare beneficiary for therapy services while they were an inpatient, but after discharge from the hospital, our utilization review people change the Medicare beneficiary from inpatient to outpatient status because they did not meet inpatient criteria, is functional limitation reporting required on the Medicare beneficiary?
Question – Posted March 6, 2015 How will I know if my claim was successfully submitted to my Medicare contractor?
Question – Posted March 6, 2015 I have a patient who I saw only once, for their initial evaluation. I assigned G codes for current status and projected goal status. Patient did not return to therapy. Should I assign D/C status G code on the date of evaluation?
Question – Posted September 9, 2014
When discharging a Medicare patient from therapy that was seen for more than just an evaluation, how many G-codes are to be reported on the claim form?
Question – Posted September 9, 2014 Must I bill an evaluation or re-evaluation in order to report G codes on the claim form?
Question – Posted August 20, 2014 I have a question in regard to the new requirement for functional reporting going into effect for UHC and Oxford Medicare managed care plans, on August 1st. For patients already on program prior to August 1st, do you know if reporting should begin on their first visit on or after August 1st , or does it only apply to new patients beginning with their evaluation on and after that date?
Question – Posted July 22, 2014
If I am treating a Medicare beneficiary for one condition (i.e. knee) and selected mobility as their categorical functional limitation and on a subsequent visit, while still treating the knee, they present with a physician referral/order for a new condition (i.e. shoulder) and I determine self care is the primary categorical functional limitation for the shoulder, how do I report the G codes?
Question – Posted July 3, 2014 – Updated Answer
The above is now supposed to be working since May 6, 2014 per the Medicare contractors due to fixes CMS has made.
We have a patient that is currently private but will become Medicare eligible on June 6, 2014. My question is how do we submit G-codes to get reimbursed once she switches over in June without having an evaluation code?
Question – Posted May 19, 2014 I know we need to report g codes every 10 treatment session or 60 days, whichever is less. Please clarify: When talking about 60 days- is that from the last treatment session, or the last date on which g codes were reported on a claim form?
Question – Posted May 9, 2014 When doing a one time wheelchair evaluation and making a recommendation for a wheelchair, do you apply the impairment limitation on all three G codes as the same level which in this case was CM? Or do you project that he will receive the wheelchair and use the CJ impairment on your discharge G code?
Question – Posted May 9, 2014 We have a patient that came in for an initial evaluation in April and he had a Medicare Advantage plan at that time. In May he switched back to traditional Medicare. Not sure how to handle G codes in this scenario. In May we won’t be billing a 97001 because that was already billed in April. Do we put G codes on the first May visit even though we are not billing an evaluation or re-evaluation?
Question – Posted May 6, 2014 We have a Medicare patient who came for 4 visits due to left hip bursitis. She abruptly ended therapy on 4/3/14 and we did not report the discharge G-codes. She came back on 4/22/14 with a new prescription wanting us to treat her low back now. We would like to use the set of mobility G codes for both cases. How do we bill that? Can we put G8979 and G8980 with modifiers on the 4/3/14 claim and then use G8978 and G8979 with modifiers for the new diagnosis on 4/22/14? Or is there a better way to do this?
Question – Posted May 3, 2014 Regarding maintenance therapy on a Medicare Part B patient, would functional limitation reporting still be required?
Question – Posted May 3, 2014 How do we bill for a patient referred by a physician for pre-op gait training? Does it matter if there is no formal evaluation completed? This question is in regards to all insurances, Medicare and private? If Medicare, would I have to report G-codes?
Question – Posted April 24, 2014 I have a patient who I evaluated in OT and reported Self Care related G codes for their primary functional limitation. I am still working with her for her self care limitation and now she is referred for wheelchair clinic. Should I hold on assigning Mobility G codes until I discharge Self Care G codes or can I use mobility G codes on the day of her wheelchair evaluation?
Question – Posted April 23, 2014 Is it possible to change the projected goal after the time of the eval. For example a the time of evaluation, the projected goal severity/complexity modifier was CK. However, by the 10th visit, the therapist feels that the client will actual improve more than expected and thinks the client can reach CI. Can the therapist change the projected goal on the 10th visit to reflect this?
Question – Posted April 13, 2014 A Medicare beneficiary is being treated by SLP for dysphagia and the SLP is reporting the G-codes for swallowing. While still in therapy, the Medicare beneficiary has a modified barium swallow (MBS) study (CPT code 92611) completed and the SLP wants to report the functional limitation as swallowing. How do we report G-codes in this situation?
Question – Posted April 13, 2014 If a patient has Blue Cross as primary insurance and then switches to Medicare through the course of PT, when would I first report G-codes on the claim form and in the medical record?
Question – Posted April 13, 2014 I am a private practice and submit claims electronically on the CMS 1500 claim form. On the day I bill an evaluation code and also report the functional limitation G-codes, my Medicare contractor is not paying the claim. Do you know what may be happening?
Question – Posted April 13, 2014 If you have a Medicare patient that is referred to you by two different providers, for two different body parts and are evaluated by the same PT on the same day under two different POCs, do you report on only one functional limitation or on two?
Question – Posted March 27, 2014 We have a patient who had a total knee replacement and has met the functional goals for mobility, but is still having limitations with ambulating stairs secondary to balance/strength. After indicating G8980 to discharge Mobility, can we add code G8990 to report the functional limitation for balance since balance isn’t specifically listed as a functional limitation?
Question – Posted March 27, 2014 We have a Medicare patient that was treated & discharged that returned 32 days later with the same diagnosis. The G Code category reported in the first round of therapy was discharged. Can the same category of G codes be used again?
Question – Posted March 27, 2014 How do you report G-codes when you have been treating the patient for one diagnosis/condition (i.e. right shoulder pain) and reporting on a functional limitation (i.e. self care) and now they are referred for a second diagnosis/condition (i.e. left shoulder impingement) which requires an evaluation and the functional limitation for the new diagnosis/condition is the same as the current functional limitation (i.e.self care)?
Question – Posted March 18, 2014 Can G-codes be reported on a claim form without a visit being completed by that discipline on that day?
Question – Posted March 16, 2014 If we see a patient for an evaluation on a certain day, select a categorical functional limitation, report the current and projected goal G-codes on the day of the evaluation, and patient self discharges themselves, we do not go back to the last claim claim and report the projected goal and DC status G-codes and the patient comes back to the same organization for additional therapy by the same discipline more than 60 calendar days from their last visit, how do I report the G-codes on the first visit they return and I am doing a new evaluation?
Question – Posted March 16, 2014 We have had a couple of episodes where a Medicare patient has been seen for their last visit, DC G codes applied appropriately, then patient returned within a week or two due to exacerbation of symptoms, questions/concerns about their home exercise program. Nothing that would require a re-eval (no major change in status) therefore no new functional limitation was reported. Our billing folks are kicking these back to us as incorrect. I cannot find any answers to this conundrum anywhere else.
Question – Posted February 28, 2014 When a therapist sees a patient who has Medicare Part B and is being seen BID since they are under observation status, does that count as 2 treatments for the day and therefore requiring them to do a progress note and G code update every 5 days?
Question – Posted February 28, 2014 If PT and ST are following a patient can they report on their own functional limitations? For example, the patient in question has functional reporting on mobility for PT and functional reporting on swallowing for ST. However, Medicare is denying stating that only one functional limitation can be reported on at a time and I am confused by this, because nothing that PT is doing will help this patient’s swallowing and nothing the ST is doing will help the patient’s mobility status.
Question – Posted February 28, 2014 Can you do the progress note on the 8th visit then report G-codes on that visit and the 10th visit or do you have to do it all on the 10th visit?
Question – Posted February 28, 2014 Can you offer any resources that might tell us how to handle the scenario when we find out a patient has Medicare after the patient has been treated and discharged. In this case, no G-codes were applied and no specific functional test was rendered to support a modifier.
Question – Posted February 28, 2014 When you report G codes on a date of service and that will end that reporting period, does the new reporting period begin with that visit or the next visit?
Question – Posted February 20, 2014 Can G codes be charged on a date without other therapy charges if the patient is discharged unexpectedly, or should they be added to the bill of the last date of service?
Question – Posted February 20, 2014 Our organization is submitting G-codes correctly and timely on the claim form, but are having some, if not all of our claims, denied when we place the applicable G-codes on the claim form. Any idea why this may be happening?
Question – Posted February 16, 2014 If I have a patient that I have evaluated and initiated treatment on with a hip diagnosis and functional limitation of mobility at 40%, then that patient is referred for a knee diagnosis on the contralateral side on visit 7, I use a different functional tool but still have a limitation category of mobility at 70% limitation, how do I report the g-codes?
Question – Posted February 13, 2014 We have an existing patient changing insurance from United Healthcare to Medicare. Should we do a re evaluation with g codes for Medicare?
Question – Posted February 13, 2014
We have several patients who are retired state employers who on 2/1/14 switched from Medicare to a Medicare HMO. Therefore they no longer require G codes. However do we need to discharge the G codes on their last date of service in January?
Question – Posted February 13, 2014 For outpatient PT, the patient is evaluated and the G-code is set for the current status and the projected goal status. That patient is seen for subsequent treatments and then the patient cancels the last two appointments and no DC G-code is applied. The claim is denied. Is there any way to capture the DC G-code in order to resubmit the claim for payment?
Question – Posted February 13, 2014 What is your understanding of coding/claim submission in the case of unexpected discharge (no formal re-assessment of status?)
Question – Posted February 13, 2014 Since November of 2013, we have had a consistent denial of payment for ALL new patients when we bill 97001 CPT code. All other CPT codes for that initial date are also denied. If we remove the 97001 code for the initial visit, then all other CPT codes are paid. Can you help me?
Question – Posted February 13, 2014 I performed a physical therapy evaluation on a Medicare beneficiary and reported the current functional status G-code and projected goal G-code for the 3 functional categories the patient has limitations in which were mobility, self-care, and carrying, moving, and handling objects. Medicare denied the date of service and I do not know why?
Question – Posted February 13, 2014 If G-code reporting is required on a particular date of service and I forget to report the G-codes on the claim form, what will happen and what should I do to correct the error?
Question – Posted February 13, 2014 How does CMS track the reporting of a Medicare’s beneficiary functional limitations?
Question – Posted January 25, 2014 I am being told that I must report G codes every 10 visits or 60 calendar days from the start of care. Can you verify or explain?
Question – Posted January 25, 2014 I had a patient that had a private insurance when they began therapy and has now switched to Medicare. How do I report the G-codes?
Question – Posted January 9, 2014 With the beginning of the new calendar year, do we have to re-report the functional limitation G codes on the Medicare beneficiaries first visit in 2014 on the claim form and in the medical record?
Question – Posted January 9, 2014 If I am treating a Medicare beneficiary for one condition (i.e. knee) and selected mobility as their categorical functional limitation and on a subsequent visit, while still treating the knee, they present with a physician referral/order for a new condition (i.e. lymphedema) and will be evaluated and treated by another therapist of the same discipline who determines self care is the primary categorical functional limitation as a result of their upper extremity lymphedema, how do I report the G codes?
Question – Posted December 10, 2013 – New Scenario I am in private practice and have been submitting G-codes with a zero charge on the 1500 claim form. My claims are now being rejected. Has something changed?
Question – Posted December 10, 2013 – Updated Answer If a Medicare patient is seen for one visit only, does the “Projected Goal” code need to go on the bill?
Question – Posted November 29, 2013
An episode is completed and patient is discharged. Patient returns in 2 weeks with a new prescription for a new problem. Can we use the same functional G code group for this new episode?
Question – Posted November 5, 2013 If I evaluated a patient who had surgery on his right wrist and I chose self care as the functional limitation category and now the patient has had surgery on the left wrist and will be coming for an evaluation on the left wrist while I am still treating the right wrist, how do I report the G codes?
Question – Posted November 3, 2013 (Updated answer from CMS in bold) If a SLP bills 92506 on one day and selects voice as the primary functional limitation and while still treating the Medicare beneficiary for voice, completes a swallow evaluation and bills 92610 on a subsequent visit, how do I report G codes for the swallow evaluation on the claim form for that date of service?
Question – Posted November 3, 2013 (Updated answer from CMS in bold) If an L-Code is the only code used on a patients first visit and then the patient returns for a follow-up visit where the patient receives treatment coded using “common/always therapy” codes, is a G-code required? If yes, which visit would the counting of “10 visits” begin?
Question – Posted September 13, 2013 I have a rotator cuff repair patient that I have been treating for a few weeks. Recently he received a manipulation under anesthesia. I understand I will need to complete a re-evaluation. Do I report discharge codes on his last day (treatment day prior to manipulation) and then report new G codes upon his return to treatment?
Question – Posted September 13, 2013 Can I bill a re-evaluation every time I report G codes on the claim form and in the therapy medical record documentation?
Question – Posted September 10, 2013 I have a question regarding patients seen for multiple diagnosis. It has always been the practice in the Outpatient hospital sites that I work at that if a patient who is currently in care comes in with a new referral for a different body part, a new account/plan of care is established. It is cumbersome for therapists to have the two accounts, however I was told from a coding and documentation standpoint that is how it should be set up. With the introduction of the G codes, these dual accounts are causing our Billing department issues. Medicare guidelines indicated one set of G codes per patient, however our billing department is asking that we submit a G code for each of these plans of care. I am wondering if you know of what the best practice is for these situations?
Question – Posted September 10, 2013 What is the difference between a reporting episode and a reporting period as it pertains to the Medicare G codes?
Question – Posted September 10, 2013 What happens if a Medicare beneficiary stops coming to therapy unexpectedly and then returns a few weeks later to resume therapy?
Question – Posted September 10, 2013 We have a Medicare beneficiary on our acute rehab unit and the beneficiary only has Medicare Part B benefits. Do we need to report G codes on this Medicare beneficiary?
Question – Posted September 4, 2013 Do you need to submit G-codes for splinting? On the one hand, it is a one time visit, but if they are just charging for the L- code and no evaluation charge then do they need to be done? Is it reasonable to only charge the L code and not an evaluation?
Question – Posted September 4, 2013 Patient being seen under mobility G-code x 5 PT visits, he then comes in to his next visit with a vendor and a script for a W/C evaluation, do we: A: Not assign a G-Code to the W/C evaluation since he is already under another code B: Assign all 3 G-Codes for the W/C evaluation because this is a one-time event and a separate script
Question – Posted August 15, 2013 We work in a SNF and provide physical therapy to residents who live here through their Med B benefit. When a resident who has been receiving services gets admitted back to the hospital and then comes back and they are still Med B – do we start with new G-codes with the evaluation back from the hospital or do we continue with the same G-codes that we were working on prior to the hospitalization?
Question – Posted August 15, 2013 I was wondering if CMS has provided any guidance for G-codes in regards to a one time fitting for an orthosis. For example, I had an order today for fitting of a cock-up wrist splint for a patient with diagnosis of sprain. (MD is waiting on report from radiologist to rule out fracture). What category or limitation do we use?
Question – Posted August 15, 2013 Is there any guidelines for the discharge G code for inpatients who are observation status? If you do not know it is your last session with the patient. and your plan is to continue PT do you still consider that last session the discharge session and submit a discharge G code?
Question – Posted August 2, 2013 If a patient is admitted to the hospital as an inpatient, the next day someone realizes that a mistake was made and they convert them to Observation status, but the PT evaluation was done when they were an inpatient or PT was not aware that they had been switched to Observation status, can the G code be submitted on the treatment day after the evaluation?
Question – Posted August 2, 2013 For private practices billing on the CMS-1500 claim form, must we assign a DX pointer for each G code reported in Box 24E?
Question – Posted July 5, 2013 Can the Other PT/OT ONLY be used with lymphedema, incontinence and wound care? We have a patient who does not have functional limitations but mostly ROM limitations that are not affecting function. Can the other category be used in this case?
Question – Posted July 4, 2013
When billing an evaluation or re-evaluation in a non-private practice setting on the UB-04 claim form, must I use the revenue codes for an evaluation or re-evaluation on the line of service for the G-codes?
Question – Posted June 30, 2013 For non-private practices billing on the UB-04 claim form, are revenue codes required on the line of service for the G-codes?
Question – Posted June 30, 2013 When billing the G-codes on the claim form, must I complete the “units” field for the functional G-code line of service?
Question – Posted June 30, 2013 Does the reporting of G-codes apply to Medicare beneficiaries evaluated and/or treated in a hospital emergency department?
Question – Posted June 30, 2013 If we see a Medicare beneficiary while under observation status and then they are admitted to inpatient status, do we still report G-codes?
Question – Posted June 30, 2013 Does the reporting of G codes apply to Medicare beneficiaries under observation status?
Question – Posted June 30, 2013 If a Medicare beneficiary is being seen by both PT and OT, could each discipline select the same functional categorical limitation?
Question – Posted June 30, 2013 If an SLP bills 92610 for an evaluation of oral pharyngeal swallowing function on one day and on a subsequent day, performs and bills for a modified barium swallow study (CPT Code 92611), how do I report the G codes on the day when I bill 92611?
Question – Posted June 28, 2013 If I have started treatment without reporting G codes in June, do I enter the G codes the first time I treat the Medicare beneficiary in July even if it is before the 10th visit? Or do I wait until the 10th visit or met goal, whichever comes first?
Question – Posted June 18, 2013 Is the AM-PAC (Boston University Activity Measure for Post Acute Care) one of the “approved” outcomes tools for use in “defining” G-codes?
Question – Posted June 18, 2013 If I am assessing for a progress report on say the 9th visit, can I go ahead and do the Progress Report and enter the G code at that time even if goal isn’t met? (For instance if I know the PTA will be doing the 10th tx)
Question – Posted June 11, 2013 I am part of an institution and we bill on a UB04 monthly. Our bills for the prior month drop on the 4th or the 5th of the following month. Is the mandatory reporting and use of G codes starting on July 1 for bills received by Medicare?
Question – Posted May 23, 2013 Are G codes required on Medicare replacement plans?
Question – Posted May 16, 2013 If I only bill an L code for an orthosis for a one time visit and no other CPT codes, do I need to report the G codes?
Question – Posted May 13, 2013 If the Medicare beneficiary unexpectedly stops coming to outpatient therapy, what G codes do I report and how do I report them?
Question – Posted May 13, 2013 Do the Medicare G codes apply only to traditional Medicare plans or to Medicare replacement plans as well?
Question – Posted May 13, 2013 The Medicare program requires the reporting of G codes at minimum every 10 visits from the outset of care. Is there a grace period if providers exceed the 10 visits?
Question – Posted May 11, 2013 If I am only seeing a Medicare beneficiary for one visit, which G codes do I report?
Question – Posted May 11, 2013 When reporting CPT codes, G-codes, and codes for PQRS, is there any particular order to place the codes in on the claim form?
Question – Posted May 11, 2013 How do I report a second functional limitation?
Question – Posted March 31, 2013 Can I report more than one functional limitation at the same time?
Question – Posted March 31, 2013 Can two different disciplines (i.e. PT and OT) report the same functional limitation?
Question – Posted March 31, 2013 What is the impairment limitation restriction range for each severity modifier?
Question – Posted March 7, 2013 Is it possible for the severity modifier to be the same for both current status and projected goal status?
Question – Posted March 7, 2013 What type of documentation is required in the medical record to support how the severity modifiers were chosen?
Question – Posted February 16, 2013 Can a PTA or COTA determine the G codes and severity modifiers?
Question – Posted February 16, 2013 Who can complete the functional reporting in the medical record?
Question – Posted February 16, 2013 Will this apply to beneficiaries who have Medicare as secondary?
Question – Posted January 27, 2013 Will the Claims-Based Data Collection strategy apply to Medicare Advantage plans?
Question – Posted January 27, 2013 How will CMS collect this data?
Question – Posted January 27, 2013 When do we have to start reporting the patients functional limitation?
Question – Posted January 27, 2013 When do providers have to report the G-codes?
Question – Posted January 27, 2013 Are the new functional limitation reporting requirements the same as PQRS?
Question – Posted January 27, 2013 Will the Medicare program pay for the reporting of the G-codes on the claim form?
Question – Posted January 27, 2013 What modifiers must be applied to the non-payable G-codes on the calim form?
Question – Posted January 27, 2013 Do I need to apply the KX modifier to the non-payable G-codes on the claim form?
Question – Posted January 27, 2013 How will I know if my claim was successfully submitted to my Medicare contractor?
Question – Posted January 27, 2013 What settings does the Claims-Based Data Collection strategy apply to?
Question – Posted January 27, 2013 What is the Claims-Based Data Collection strategy for therapy services?
Question – Posted January 27, 2013
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