G-Codes: Another curve ball from Medicare

Physical Therapy Billing | medicare-g-codesBy Rebecca Harwood – SWAT 

Medicare is now requiring that G-Codes and C-modifiers are included on your physic claims and in your documentation. Not only do you as the provider need to change the way you bill but also the way you document. This change is very complex and can not be done from your memory alone. If these requirements are not met, you will not get paid by Medicare and these claims will be denied. We are here to help and have upgraded bestPT in several ways to handle these new requirements.

The G-Codes are used on your Initial Evaluations, Progress notes/Re-evals and Discharge visits to track the patient’s progress in reaching their goals. These codes are used to demonstrate medical necessity and ensure that the patient is getting better. In addition to billing out these G-Codes, you also have to add C-modifiers depending on the severity of their condition. You also need to document these codes in your documentation and ensure that it is supported with functional testing (e.g., Dash, Tinetti, etc). Any claims submitted after July 1, 2013 that do not have G-Codes on the required visits will be denied. If these findings are not documented, you are at risk for an audit.

The G-Codes and C-modifiers have been added to all procedures for clinicians with the PT, OT, and/or SLP specialty code. These can be found in your Procedures list in the Billing and EHR screen. We have put in several validations that will flag any claim missing the G-Codes and C-modifiers. These claims will be sent back to your provider workbench for review. We have also created a new xDoc template that allows you to document the Initial Evaluation, Progress Note, and Discharge Summary all in one xDoc template so you will be able to track the overall progress of the patient. This template also has the Functional Assessment Tools (e.g., Dash, Tinetti, etc) complete with automatic calculations to support your G-Code and C-Modifier reporting. To add this xDoc template to your account, please open a ticket to your SPOC.
We have held two webinars on these updates this month and will be publishing a downloadable version in the next couple weeks. If you have any questions or concerns regarding these new requirements, please do not hesitate to open a Vericle ticket to your SPOC. We also run Live Help Sessions, 1-3 times a day. Check your bestPT  Live Help Calendar for information on how to join these sessions.


Watch our G-codes webinar (60 minutes long) with Dave Alben and Kathleen Casbarro: