Explore G-Code Survey Responses
Not long ago, we provided a survey on G-code use in an attempt to gather useful information from providers that they can share with each other on ‘what they have learned’ during this new Medicare mandated, Claims-Based Outcomes Reporting (CBOR).
As promised, now that everyone has had more than a few months to experience the workflow, the lessons learned and the best information on how to avoid a denial; it’s time to circle back to see the responses.
25 Sites Responding:
- Who Manages G-Codes: (All that apply – 25 sites have a combination of 48 responses)
Licensed Therapist; 22 – 46%
Licensed Therapist Assistant: 3 – 6%
Support Staff: 9 – 19%
Billing Staff: 14 – 29%
By and large the licensed therapists are not only applying but managing the process within their facilities.
Has the 2 midnight rule pt stay reduced confusion of when to apply the G-Codes to therapy services?
19 Responses: 6 YES – 13 NO
How many denials has your facility experienced since initiating G-Code modifiers?
- Admission code not on the final UB when multiple UB’s have been sent for billing. Contractor believing it should have been.
- Denied at D/C when only current status and D/C codes on the bill. Rebilled including admission codes.
- Closing the case if the patient is not seen. Should we or shouldn’t we? CMS states not necessary.
- Communication breakdown for observation patients still exists. 60 days before CMS closes episode is challenging.
- Measurement valid tools for musculoskeletal pain when a patient pushes through and ADL skills are accomplished despite pain improvement.
- Rules for inpatient, observation patients and swing bed patients.
- Fixing G-code errors after the fact is extremely time consuming for ‘reporting only’ bill updates.
- Just remembering to code at the right time when not all patients are Medicare.
- Different documentation systems utilized on inpatient vs. outpatient. When patients are in observation the inpatient system is utilized.
- Picking correct codes and deciphering the percentages of impairment is confusing given the scale options.
Most Common Denial Reasons Received:
- Current and goal/goal and discharge were not a PAIRED SET so therefore denied.
- Inadequate G-code utilization (1 at d/c or all 3 used at discharge and not accepted).
- Modifiers not printing out on the UB claim when processed.
- Claim adjustments for unknown reason.
- Discharge G-codes not present.
- Forgotten codes – bill already processed.
- Procedure code inconsistent with modifier utilized/or modifier missing when needed.
- Denial code 31816 (Return to Provider): You are receiving this reason code when the claim contains any of the following evaluation/re-evaluation therapy codes 92506, 92597, 92607, 92608, 92610, 92611, 92612, 92614, 92616, 96105, 96125, 97001, 97002, 97003, 97004, and the claim is billed without the functional G-code(s) and the appropriate modifier(s).Effective July 1, 2013, outpatient therapy providers are required to report a combination of two non-payable G-codes to show the beneficiary’s functional limitations (i.e., G8979 and G8979). In addition, each G-code must contain the appropriate therapy modifier(s) to indicate Physical/Occupational (PT/OT) or Speech Language (SLP) therapy (i.e., GP, GO, GN), along with the severity modifier (i.e., CJ) to indicate the severity/complexity for that measure.
- CO119 (Maximum Benefit Reached): CO 119 Benefit maximum for this time period or occurrence has been reached.
Stay tuned for additional information learned at the APTA conference at a Combined Sections session in Las Vegas and for a special guest webinar in April on G-codes.
Have you visited our Clarifications on CBOR and G-codes FAQ yet? It includes more than 75 questions asked by the rehabilitation industry. Check it out, you might get your questions answered!