HCPCs Require G Codes and C Modifiers
Effective January 1, Medicare B claims for specific therapy services can include G-codes and
severity/complexity modifiers that provide information about a beneficiary's status at the beginning of therapy, at specified points during treatment, and when discharged from therapy. Learn more at:
MLN Matters Number MM8005 Revised.
Preparing for Therapy Required Functional Reporting Implementation
This update adds G code reporting capability to the Hi-Tech Resident Accounting and Rehab Therapy. You can submit bills with these codes through the testing period that ends on June 30.
Use of the codes is mandatory as of July 1, 2013.
Hi-Tech has scheduled four webinars to address these changes.
Therapy G Codes and Modifiers for Rehab Therapy System Thursday, 2/20/13 2-2:45 pm Thursday, 2/21/13 10-10:45 am
Therapy G Codes and Modifiers for Resident Accounting Friday, 2/15/13 10-10:45 am Thursday, 2/21/13 2-2:45 pm Contact Webinars@Hi-TechSoftware.com if you did not receive an invitation to each of these webinars.
IMPORTANT: These Webinars will NOT address therapy interfaces for billing purposes.
We will schedule future webinars that demonstrate how our Therapy Interface Programs handle the new G Coding requirement, and how to manually enter Therapy Charges that require G Coding.
Table of Contents
HCPCs Require G Codes and C Modifiers ... 1
HCPCs that will require G Codes... 2
G codes that Require C code modifiers ... 2
Resident Accounting and HCPC G Coding ... 4
As of July 1, 2013, specific HCPC-coded procedures will require G codes, which are non-billable codes used to report Functional Limitations for Medicare B Outpatient services. Each use of a G Code will also require a C modifier that indicates the Impairment Limitation Restriction.
Release 13.02 adds all G codes and C code modifiers to the Ancillary Charges Library and the Medicare B Fee Schedule.
HCPCs that will require G Codes
HCPC Procedure HCPC Procedure
92506 Speech/hearing eval 92616 Fees w/laryngeal sense test 92597 Oral speech device eval 96105 Assessment of aphasia 92607 Ex for speech device rx 1 hr 96125 Cognitive test by hc pro 92608 Ex for speech device rx addl 97001 PT evaluation
92610 Evaluate swallowing function 97002 PT re-evaluation 92611 Motion fluoroscopy/swallow 97003 OT evaluation 92612 Endoscopy swallow test 97004 OT re-evaluation 92614 Laryngoscopic sensory test
G codes that Require C code modifiers
G HCPC Short Description
Mobility: Walking & Moving Around
G8978 Mobility current status G8979 Mobility goal status G8980 Mobility D/C status
Changing & Maintaining Body Position
G8981 Body pos current status G8982 Body pos goal status G8983 Body pos D/C status
Carrying, Moving and Handling Objects
G8984 Carry current status G8985 Carry goal status G8986 Carry D/C status
Self-Care
G8987 Self-care current status G8988 Self-care goal status G8989 Self-care D/C status
Other PT/OT Primary
G8990 Other PT/OT current status G8991 Other PT/OT goal status G8992 Other PT/OT D/C status
Other PT/OT Subsequent
G8993 Sub PT/OT current status G8994 Sub PT/OT goal status G8995 Sub PT/OT D/C status
Swallowing
G8996 Swallow current status G8997 Swallow goal status G8998 Swallow D/C status
Motor Speech
G8999 Motor speech current status G9186 Motor speech goal status G9158 Motor speech D/C status
Spoken Language Comprehension
G9159 Lang comp current status G9160 Lang comp goal status G9161 Lang comp D/C status
Spoken Language Expression
G9162 Lang express current status G9163 Lang express goal status G9164 Lang express D/C status
Attention
G9165 Atten current status G9166 Atten goal status G9167 Atten D/C status
Memory
G9168 Memory current status G9169 Memory goal status G9170 Memory D/C status
Voice
G9171 Voice current status G9172 Voice goal status G9173 Voice D/C status
Other SLP
G9174 Speech lang current status G9175 Speech lang goal status G9176 Speech lang D/C status
C 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 than 40 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
Resident Accounting and HCPC G Coding
Libraries > Charges / GL Coding > Ancillary Charges
The Edit Ancillary Records screen now includes two new checkboxes: This update modifies the HCPCs that require G codes.
These HCPCs will be check-marked at Requires G HCPC Code. The update also adds the 42 G HCPCs that require a C Modifier.
These G HCPCs will be check-marked at Requires G Code Modifier.
Receipts / Charges / Adj > Ancillary Charges:
After you enter a charge for a HCPC that requires a G HCPC (Example: 97001 for PT Evaluation), you will also enter a non-billable charge for the required G HCPC.
At Item after you select a G HCPC, the program will display the Select a Modifier screen. Choose the correct C-code modifier for this item. You cannot exit the list until you select the modifier.
Your selection will appear on the right under HCPC Codes in the Mod-2 area.
The charge can be saved with a zero amount and zero units, amount cost and visits.
Print/Post Transaction Audit will post the G code HCPC with the C Modifier with zero units and zero dollars to detail.
Sample Audit report with G coded HCPCs
Sample Resident Detail:
Billing > Medicare B > Select Bills will include G code HCPCs as a $0.01 (1 cent) charge. If entered by mistake for non-Medicare B payers, the charge will not be pulled to the UB.
Rehab Therapy System and G Codes HCPCs
Therapy > Rehab Therapy > Libraries > Procedures: Includes check boxes for identifying therapy HCPCs that require G codes, which also require a C modifier code.
For example, the HCPC Code 97001 is check-marked at Requires G HCPC Code.
G HCPC Code G8978 is check-marked at Requires G Code Modifier.
This update adds these items to the Rehab Therapy Procedures Library.
Daily Procedures > Enter Daily Time: After you record a procedure that requires a G code (such as 97001, you must also enter the G code item.
When you enter any detail, i.e. New Time, for the G HCPC, press the Enter or Tab or click in another area, and the screen will display the Select a Modifier for: screen (sample on the right) so you can select the G Code Modifier.
HCPC that Requires G HCPC Code
Reporting > Daily Therapy Time: Recorded therapy time that requires G codes will be indicated in the HCPC column by the code and the G code modifier. Minutes, visits and charges detail will not be included.
A summary of G code information will appear at the end of the report.
Reporting > Documentation Record will include the G code HCPCs with the modifiers in the CODE column. The user’s initials will print in the day column. The time will not be printed.
Reporting > Print Monthly Summary: will include the G coding in the Procedure description on the left. An X will be printed in the therapy day column.
Resident Accounting > End of Month > Therapy Charges > Rehab Therapy Charges will post the G code HCPCs to the AR detail transaction file as zero units and prices. Posting will skip G code detail prior to 3/1/2013.
