G-Codes for Functional Reporting and Severity/Complexity Modifiers

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 19th, 2015

Beginning January 1, 2013, Functional Reporting requires therapy practitioners and providers to report non-payable G-codes and modifiers to convey information about the beneficiary’s functional status including projected goal status throughout the episode of care. 

For the severity modifiers, providers should include a description of how the modifiers were determined.

Functional reporting is required on claims throughout the entire episode of care.

For each non-payable G-code reported, a modifier must be used to report the severity level for that functional limitation.

Functional Reporting is required on therapy claims for certain dates of service (DOS) as described below:

Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy, and speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services. For example, respiratory therapy services, or nutrition therapy services shall not be represented by therapy codes which require GN, GO, and GP modifiers.

Contractors edit institutional claims to ensure the following:

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. For more information click on the link below to see a quick reference chart.

 
 MLN- Quick Reference Chart: Short & Long Descriptorsfor Therapy Functional Reporting G-codes and SEVERITY/COMPLEXITY MODIFIERS

References:

G-Codes for Functional Reporting and Severity/Complexity Modifiers. (2015, August 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/g-codes-for-functional-reporting-26618.html

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