Health Information Management

Q/A: How do we report therapy G codes and modifiers for multiple therapies?

APCs Insider, June 14, 2013

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Q: Our outpatient rehab department is having some discussion about how to report the G codes and modifiers. They are struggling with how to report the codes when the patient has multiple reasons for attending therapy.  

A: According to CMS guidelines, coders should report one functional limitation at any given time for each therapy plan of care. The limitation must be reported for:
  • The first date of therapy service
  • At least once during each 10 days that therapy services are provided
  • With any evaluative or re-evaluative procedure
  • At time of discharge from therapy
  • When the reporting of one limitation ends and additional therapy is necessary
  • At the time that reporting starts for a new or different limitation within the same episode of care
Reporting is required through the entire episode of care and only one limitation can be reported at a given time.
 
 If the patient has multiple reasons for needing therapy services, one is selected and reported with the appropriate set of codes. Once treatment for that limitation is completed, coders may report another with another set of codes, if the patient needs additional therapy services. 
 
If the beneficiary stops participating in therapy before discharge is warranted, the functional information is reported on the last claim.  
 
Detailed information is available in the CMS Claims Processing Manual (Pub 100-04), chapter 5, section 10.6.
 
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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