HCPCs Require G Codes and C Modifiers

Transcription

1 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, Hi-Tech has scheduled four webinars to address these changes. Therapy G Codes and Modifiers for Rehab Therapy System Thursday, 2/20/13 Thursday, 2/21/13 Therapy G Codes and Modifiers for Resident Accounting 2-2:45 pm 10-10:45 am Friday, 2/15/ :45 am Thursday, 2/21/13 2-2:45 pm Contact [email protected] 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 Rehab Therapy System and G Codes HCPCs... 7 G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 1

2 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 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 Speech/hearing eval Fees w/laryngeal sense test Oral speech device eval Assessment of aphasia Ex for speech device rx 1 hr Cognitive test by hc pro Ex for speech device rx addl PT evaluation Evaluate swallowing function PT re-evaluation Motion fluoroscopy/swallow OT evaluation Endoscopy swallow test OT re-evaluation 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 G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 2

3 G8996 G8997 G8998 G8999 G9186 G9158 G9159 G9160 G9161 G9162 G9163 G9164 G9165 G9166 G9167 G9168 G9169 G9170 G9171 G9172 G9173 G9174 G9175 G9176 C Modifier CH CI CJ CK CL CM CN Swallowing Swallow current status Swallow goal status Swallow D/C status Motor Speech Motor speech current status Motor speech goal status Motor speech D/C status Spoken Language Comprehension Lang comp current status Lang comp goal status Lang comp D/C status Spoken Language Expression Lang express current status Lang express goal status Lang express D/C status Attention Atten current status Atten goal status Atten D/C status Memory Memory current status Memory goal status Memory D/C status Voice Voice current status Voice goal status Voice D/C status Other SLP Speech lang current status Speech lang goal status Speech lang D/C status Impairment Limitation Restriction 0 percent impaired, limited or restricted At least 1 percent but less than 20 percent impaired, limited or restricted At least 20 percent but less than 40 percent impaired, limited or restricted At least 40 percent but less than 60 percent impaired, limited or restricted At least 60 percent but less than 80 percent impaired, limited or restricted At least 80 percent but less than 100 percent impaired, limited or restricted 100 percent impaired, limited or restricted G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 3

4 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. G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 4

5 Receipts / Charges / Adj > Ancillary Charges: After you enter a charge for a HCPC that requires a G HCPC (Example: 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. G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 5

6 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. Sample UB04 screen: G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 6

7 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 is check-marked at Requires G HCPC Code. G HCPC Code G8978 is check-marked at Requires G Code Modifier. HCPC that Requires G HCPC Code 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. G HCPC that requires a G Code Modifier 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. G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 7

8 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. G:\HITECH\Webinars\Webinar Docs\Gcodes.docx Page 8