Functional Reporting

February 14, 2013
Rick Gawenda

The Centers for Medicare and Medicaid Services will require providers to report patient functional status at certain intervals during their episode of treatment. This began on January 1, 2013 on a voluntary basis and will be mandated to be reported on claim forms and in the therapists documentation beginning on July 1, 2013 for all traditional Medicare patients. Plan on attending my webinar titled “2013 Medicare G Codes: Mandated Reporting of Patient Functional Status” to be held on April 24, 2013 from 1:00PM – 2:00PM EDT. For additional information and to register, click HERE.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. Example: A patient comes to therapy for “pre-op” to get instruction on exercises/care prior to surgery & an evaluation is NOT being done. This would be a one-time visit prior to surgery with the eval taking place on the 1st therapy visit after surgery. Can a PTA perform this pre-op service if (1) unit of 97110 is charged using G8990, G8991 & G8992 with CH mods OR does a PT need to see the patient for this one-time pre-op visit?

    1. In my opinion, this visit must be done by a PT for several reasons. First, a PT should always see the patient for their first visit to determine what is required. Second, PTAs can’t determine the treatment plan for a patient. That is done by a PT. Third, functional limitation reporting is only done by a therapist and not a therapist assistant. There are additional reasons as well.