Functional Limitation Reporting Codes and Modifiers

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 16th, 2016

The following G-codes are used for reporting on claims for Medicare Part B and must be used with a severity/complexity modifier, the use of G-codes are enforced and required beginning Jan. 01, 2013, claims will be returned or rejected if they do not contain the required functional G-Code/modifier information.

There are 42 functional G-codes, 14 sets of three codes each. Six of the G-code sets generally describe PT and OT functional limitations, and eight sets of G-codes generally describe SLP functional limitations.

Only one functional limitation shall be reported at a given time for each related therapy plan of care (POC). However, functional reporting is required on claims throughout the entire episode of care; so, there will be instances where two or more functional limitations will be reported for one beneficiary’s POC, just not during the same time frame.

In these situations, where reporting on the first reported functional limitation is complete and the need for treatment continues, reporting is required for a second functional limitation using another set of G-codes. Thus, reporting on more than one functional limitation may be required for some beneficiaries, but not simultaneously.

Specifically, functional reporting, using the G-codes and modifiers, is required on therapy claims for certain DOS as described below:

• At the outset of a therapy episode of care, i.e., on the DOS for the initial therapy service;

• At least once every 10 treatment days -- which is the same as the newly-revised progress reporting period -- the functional reporting is required on the claim for services on same DOS that the services related to the progress report are furnished;

• The same DOS that an evaluative procedure, including a re-evaluative one, is submitted on the claim (see below for applicable HCPCS/CPT codes);

• At the time of discharge from the therapy episode of care, if data is available; and,

• On the same DOS the reporting of a particular functional limitation is ended, in cases where the need for further therapy is necessary. As noted above, this functional reporting coincides with the progress reporting frequency, which is being changed through this instruction. Previously, the progress reporting was due every 10^th treatment day or 30 calendar days, whichever was less. The new requirement is for the services related to the progress reports to be furnished on or before every 10thtreatment day.

In the example below, the G-codes for the mobility functional limitation (G8978 -8980) are used to illustrate the timing of the functional reporting.

•  At the outset of therapy-- the DOS the evaluative procedure is billed or the initial therapy services are furnished:

G8978 and G8979, along with the related severity modifiers, are used to report the current status and projected goal status of the mobility functional limitation.

•  At the end of each progress reporting period --the DOS when the progress report services are furnished: oG8978 and G8979, along with the related severity modifiers, are used to report the current status and projected goal status of the mobility functional limitation.

This step is repeated as clinically appropriate

• At the time the beneficiary is discharged from the therapy episode -- the DOS the discharge progress report services are furnished

G8979 and G8980, along with the related severity modifiers, are used to report the projected goal and discharge status of the mobility functional limitation.

In the above example, if further therapy is medically necessary once reporting for the mobility functional limitation has ended, the therapist begins reporting on another functional limitation using a different set of G-codes.

Reporting of the next functional limitation is required on the DOS of the first treatment day after the reporting was ended for the mobility functional limitation

Mobility Status

G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals

G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting

Changing & Maintaining Body Position Status

G8981  Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals

G8982  Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8983  Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting

Carrying, Moving & Handling Objects Status

G8984  Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals

G8985  Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8986  Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting

Self Care Status

G8987  Self care functional limitation, current status, at therapy episode outset and at reporting intervals

G8988  Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8989  Self care functional limitation, discharge status, at discharge from therapy or to end reporting

Other Physical or Occupational Therapy Status

G8990  Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals

G8991  Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8992  Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting

Subsequent Physical or Occupational Therapy Status

G8993  Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals

G8994  Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8995  Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting

Swallowing Status

G8996  Swallowing functional limitation, current status at therapy episode outset and at reporting intervals

G8997  Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G8998  Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting

Motor Speech Status

G8999Motor speech functional limitation, current status at therapy episode outset and at reporting intervals

G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting

G9186Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

Spoken Language Comprehension Status

G9159  Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals

G9160  Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9161  Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting

Spoken Language Expressive Status

G9162  Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals

G9163  Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9164  Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting

Attention Status

G9165  Attention functional limitation, current status at therapy episode outset and at reporting intervals

G9166  Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9167  Attention functional limitation, discharge status at discharge from therapy or to end reporting

Memory Status

G9168  Memory functional limitation, current status at therapy episode outset and at reporting intervals

G9169  Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9170  Memory functional limitation, discharge status at discharge from therapy or to end reporting

Voice Status

G9171  Voice functional limitation, current status at therapy episode outset and at reporting intervals

G9172  Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9173  Voice functional limitation, discharge status at discharge from therapy or to end reporting

Other Speech Language Pathology Status

G9174  Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals

G9175  Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting

G9176  Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting

HCPCS code G0152 (services of occupational therapist in home health setting, each 15 minutes) is the only required HCPCS code in home health. All others are for informational purposes only.

For each of the above-listed non payable G-codes , a modifier must be used to report the severity/complexity for that functional measure. The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the therapist, physician, or NPP furnishing the therapy services. The beneficiary’s current status, the anticipated goal status, and the discharge status are reported via the appropriate severity modifiers. The seven severity modifiers are defined below:

Modifier      Impairment Limitation Restriction

CH              0 percent impaired, limited or restricted

CI                At least 1 percent but less than 20 percent impaired, limited or restricted

CJ                At least 20 percent but less than40 percent impaired, limited or restricted

CK              At least 40 percent but less than 60 percent impaired, limited or restricted

CL               At least 60 percent but less than 80 percent impaired, limited or restricted

CM              At least 80 percent but less than 100 percent impaired, limited or restricted

CN              100 percent impaired, limited or restricted

References:

• CMS.gov