Functional Limitation Reporting using WebPT

References G-Codes: Mobility: Walking & Moving Around G8978 Mobility: walking and moving around functional limitation, current status, at therapy episode outset, and at reporting intervals. G8979 Mobility: walking and moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. G8980 Mobility: walking and moving around functional limitation, discharge status at discharge from therapy or to end reporting. Other PT/OT Primary Functional Limitation G8990: Other physical or occupational primary functional limitation, current status, at therapy episode outset, and at reporting intervals. G8991 Other physical or occupational 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 primary functional limitation, discharge status at discharge from therapy or to end reporting.

Modifiers:

Example Your new patient Will has sought your physical therapy services following a total hip replacement. For this example, we can establish Wills primary functional limitation as Mobility: Walking & Moving Around. Because this is Wills initial examination, the corresponding G-code is G8978. Now for the modifier. Appropriate to Wills current condition, youre going to select the lower extremity functional scalean outcome measurement test (or one like it) that you should be performing on Will even without this new mandate. Will scores a 5; based on the test scoring rules that means he is at 6.25% of maximal functionor 93.75% impairmentwhich corresponds to modifier CM. So, Wills current status on his

initial examination would be G8978 CM GP. Youd want to make sure that this code appears on the claim you submit to billing for the initial exam. Now, lets tackle his goal. Youll select G8979, the code under Mobility: Walking & Moving Around that applies to projected goal status, and assign to it the CI modifier because you believe that by the end of treatment Will will improve to at least 1% but less than 20% impairment. Youd want to make sure that G8979 CI GP also appears on the claim you submit to billing for the initial exam. At the tenth visit, Wills G-code remains the same (G8978) and you perform the same outcome measurement tool. As a result of your treatment, Wills score improves to an 18; this means hes at 22.5% of maximal functionor 77.5% impairmentwhich corresponds to modifier CL. So, Wills current status on his tenth visit is G8978 CL GP. Unless there is any change to your goal for Will, his projected goal status code remains the same at G8979 CI GP. Youd want to make sure that G8978 CL GP and G8979 CI GP appear on the billing claim you submit to Medicare for this Progress Note visit. You may not bill the re-evaluation code 97002 just for submitting these codes; you may only bill 97002 if this is truly a reevaluation. On the 20th visit, Wills progress is outstanding, and he scores a 75 on the lower extremity functional scale; this means hes at 93.75% of maximal functionor 6.25% impairmentwhich corresponds to modifier CI. Will has met his goal so you discharge his primary functional limitation with G-code G8980, the code under Mobility: Walking & Moving Around that applies to discharge status (G8980 CI GP). The projected goal status code remains the same at G8979 CI GP. These codes will again appear on the billing claim for this date of service. Unless you identify a new primary functional limitation at this point, you must discharge Will from therapy. In this case, lets say that Will is also experiencing wound healing capacity limitation. This doesnt fall under any of the other functional limitation categories, and this is the first time you are assessing this limitation, so you select G8990, Other PT/OT Primary Functional Limitation, as Wills new primary functional limitation. Based on your assessment, you decide to perform the South West Regional Wound Care Toolkit and determine he has a 50% wound healing limitation, which corresponds to modifier CK. Thus, Wills new G-code is G8990 CK GP. This would appear on the billing claim on this 20th visit date of service. You can now continue to see Will with wound care as your primary limitation. Treatment and documentation of treatment must now reflect this primary limitation. As treatment continues for Will, you will repeat the steps listed above at the 30th visit, 40th visit, etc., through the discharge of the patient.

Reader Comments
You're correct in that you can only have one primary functional limitation at a time. If a new functional limitation exists once the patient reaches the goal of their initial functional limitation, youll take the following steps: - Discharge initial primary limitation. -Within the Subjective Section, determine and select a new functional limitation category. -Within the Objective Section, select a new appropriate functional assessment tool(s) or objective measure(s). -Then, based on the functional assessment tool(s), determine the severity of this new limitation and select the corresponding modifier. - Determine the new projected long-term goal based on the current functional limitation status and other patient information. - Find the appropriate G-code and modifier on your billing sheet. If you have integrated billing, these will then pass through the integration to the appropriate billing software: -Current status with severity modifier -Projected goal with severity modifier