The Centers for Medicare and Medicaid Services (CMS) implemented new G-codes for therapy functional reporting at the beginning of 2013. G-codes became required on every Medicare rehabilitation claim starting July 1st, 2013—without them, the claim is rejected. JTECH spoke with Paula White, the Practice Director of an orthopedic office, in order to better understand how G-codes are affecting the billing of functional therapy services.
"G-codes were created by CMS to measure functional outcomes data from therapy services to better identify patient condition outcomes. CMS is hoping to better understand therapy services and how patients' functional limitations may change as a result of the therapy they received. This data will be used to assist the payment reform of therapy services.
“CMS has identified 42 G-codes to describe the particular functional limitation that is requiring therapy. Therapists are required to report these codes along with modifiers which identify the severity of the limitation at the first therapy session, a minimum of every 10th visit, and at discharge.
"The percentage of disability will be determined by the measurements obtained by the therapist as well as their professional judgment. G-codes and severity modifiers must be documented as part of the medical record and claim. It is mandatory that all tools and other information used to measure these outcomes are also documented and submitted on the claim forms. If G-codes are not properly submitted and documented, claims will be rejected and returned, and payment will not be issued for those services."