FAQs – straight to the point without all the extra stuff…
Q. Do I have to use this?
A. Are you a physical therapist treating Medicare part B patients? Then the answer is yes. Starting in July 2013, you won’t get paid unless you report these. You can start earlier, if you just want to practice.
Q. Where do I report these?
A. They are submitted as non-payable codes on the medicare charge form
Q. How often do I have to report these?
A. At the eval, progress notes (every 10 visits), recertifications, re-evaluations, and discharge. If you happen to re-evaluate between progress notes, the 10 visit “counter” restarts.
Q. What if none of my patients ever show up for the discharge appointment?
A. That sucks, but Medicare understands. If you can report it, great. If you can’t, that’s ok, too. That won’t stop you from getting paid for the rest of the treatments.
Q. So, I should report two different G codes each time?
A. Yes. You will report a “current” status and a “goal” status. Each G code needs to be accompanied by a “severity modifier” to designate the patient’s status. There is a special code for the “discharge” G code that takes the place of the regular “current” status code.
Q. Does the severity modifier correlate to anything objective or functional?
A. Not really. There are no “crosswalks” between any current functional tests and the “severity modifiers”. Medicare wants you to document that you completed some established functional test that you based your severity modifier status upon, however, there’s no clear guidelines of how to convert your test score to a severity score. It’s time to break out the calculator (to do some proportion calculations), use some “professional judgement” (ie artistic license) and just roll with it.
Q: What are those last two categories on the cheat sheet all about?
A: “Other PT/OT Primary Functional Limitation” and “Other PT/OT Subsequent Functional Limitation” are to be used if none of the other measures quite fit for your patient’s measurements. The “subsequent” measure is used if they meet the first “primary” measure’s goal, but still need to continue therapy using a new goal measure.
Q: So what, exactly, do I do if the patient meets the first goal?
A. Document and report it. At the next reporting interval, you will begin reporting a new measure (current + goal status). Only report one measure at a time. Reminder: One measure = 2 codes (current and status codes)
Q. Where can I find out more about this?
Q. Where can I find a printable version of this G code cheat sheet?
A. Just enter your email in the form at the top of this page and we’ll send you a link to download the full resolution pdf file. Make sure you print it out in landscape orientation in color.
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