G-Codes: Another curve ball from Medicare
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 original G-codes webinar is no longer available.
Historical notice: CMS discontinued outpatient therapy functional-reporting G-codes and severity modifiers for dates of service on or after January 1, 2019. The requirements described in this 2013 article are no longer current. See current CMS guidance.
