Q/A: MIPS and G Codes

by  Brandy Brimhall, CPC CPCO CMCO CPMA QCC
August 24th, 2017

Question

We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good? All of our doctors are diligent about using outcome assessment tools. Here is what we currently do: -Quadruple Analog Scale- at the initial visit, every 30 days, re-exaccerbations, final exams. -Oswestrys- at the initial visit, re-exaccerbations, final exams. Is this what you would recommend continuing with, or is it overkill and unnecessary for our doctors who do not qualify for MIPS to be doing an outcome assessment (quadruple analog scale) every 30 days?

Answer 

It will not do any harm to report G codes even if the practice/provider doesn't need to. It could be somewhat overkill for those doctors that do not qualify for MIPS. However, note that Medicare is extremely strict on medical necessity guidelines and in the event one of these doctors receive medical necessity denials or records requests, these additional bits of documentation will be extremely valuable to you in supporting medical necessity and thus either not have to pay Medicare back due to their own audit findings or not getting claims denied that you are expecting payment for.

Q/A: MIPS and G Codes. (2017, August 24). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/mips-and-g-codes-34675.html

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