Using G-Codes and Severity Modifiers in Your FLR Coding
Avoid the pitfalls of FLR coding, so you can be adequately paid for your therapy services.
In order to get paid from Medicare, whether it’s the primary or secondary payer, CMS requires that therapists report patients’ functional limitations at initial evaluation, every re-evaluation (at least every 10th visit), and at discharge. To complete their functional limitation reporting (FLR), therapists use G-codes and severity modifiers, but the system can be a bit confusing. Here are some basics to help you better understand G-codes and modifiers, so you get paid what you’re owed.
According to CMS, there are “42 functional G-codes that are comprised of 14 functional code sets with three types of codes in each set. Six of the G-code sets are generally for PT and OT functional limitations and eight of G-code sets are for SLP functional limitations. Providers and practitioners report the G-code set for the functional limitation that most closely relates to the primary functional limitation being treated or the one that is the primary reason for treatment.” Here’s an example of what that means.
The 42 codes are divided into 14 code sets. Each of those sets includes three codes—for current status, goal status, and discharge status. If your patient is receiving therapy for mobility issues, then you would use the following:
G8978 – Current status
G8979 – Goal status
G8980 – Discharge status
With each patient, you report the first two codes, along with the severity modifiers, each time you are required to report. The severity modifiers provide the details about the patient’s condition at each status.
CH – 0% impaired, limited, or restricted
CI – At least 1% but less than 20% impaired, limited, or restricted
CJ – At least 20% but less than 40%
CK – At least 40% but less than 60%
CL – At least 60% but less than 80%
CM – At least 80% but less than 100%
CN – 100% impaired, limited, or restricted
For example, a patient receiving therapy for mobility issues with only minor mobility impairment might be coded G8978 CI, for current status of less than 20% limitation, and G8979 CH, for goal status of 0% impairment. The documentation in your patients’ charts should include a description of how the modifiers were determined. (See CMS’s chart of all codes and severity modifiers here.)
As mentioned earlier, functional reporting is required on therapy claims:
• At the outset of a therapy episode of care
• At least once every 10 treatment days for that episode
• At the dates of service that an evaluative or re-evaluative procedure code is submitted on the claim
• At the time of discharge from the therapy episode of care, unless discharge data is unavailable, such as when beneficiaries self-discharge or discontinue therapy unexpectedly
Although you are not required to complete FLR coding when patients self-discharge, it’s a good idea to indicate status at last treatment in case patients return for additional care, which will help you avoid billing issues in the future.
While keeping track of all the codes and remembering to report codes at least every 10 treatment days can be challenging, your EHR software should help you track visits and prevent you from billing out the 10th visit without a required FLR code. If your system isn’t helping you manage FLR coding, find a solution, such as MediLinks, that is designed specifically for rehab and can help your team stay on top of functional limitation reporting.