Eli's Rehab Report

Published on Fri Feb 22, 2013 PDF

If your patient’s limitations don’t fit a G-code description, CMS has a solution for you.

Starting this year, outpatient therapists must report functional limitation G-codes for Medicare patients at specific intervals throughout the episode of care.

The G-codes you have to choose among are grouped into several categories. For example, under PT and OT functional limitations, these categories include:

Mobility

Changing & maintaining body position

Carrying, moving & handling objects

Self care, and

Other.

Transmittal 2622 included "extensive clarification on the selection of the ‘other’ category for PTs and OTs," points out Heather Smith, PT, MPH, program director of quality for the American Physical Therapy Association.

What it says: The transmittal instructs you to use the "Other PT/OT" G-codes when:

One of the other four categories does not define the patient’s functional limitation;

Your therapy services are not intended to treat a functional limitation; or

You’ve used a functional assessment tool and the overall, composite, or other score from the tool doesn’t clearly represent a functional limitation defined by one of the other four categories.

For speech-language pathology: SLPs are to report one of eight G-code categories for their Medicare patients. Seven of these G-code categories are based on the American Speech-Language Hearing Association’s National Outcomes Measurement System (NOMS), while the eighth category is "Other SLP."

(NOMS includes a total of fifteen functional communication measures, seven of which CMS adopted for SLP G-code categories.)

CMS says you are to use the "Other SLP" category when:

The patient presents with one of the other eight NOMS-defined functional measures (not described by the existing G-code sets); or

An overall, composite or other score from an assessment tool does not clearly represent one of the seven categorical SLP functional measures.

Helpful: "NOMS is currently being reconfigured to include the G-codes and modifiers and also offers data for recommending a projected goal," says Lisa Satterfield, MS, CCC/A, director of health care regulatory advocacy for the American Speech-Language-Hearing Association. "If SLPs are looking for a streamlined approach to meeting the CMS requirements, they should look into NOMS registration and participation."