7/30/2019 FLR 2013

1/5

Functional Limitation Reporting using WebPT

7/30/2019 FLR 2013

2/5

References

G-Codes:

Mobility: Walking & Moving Around

G8978 Mobility: walking and moving around functional limitation, current status, at therapy episode outset, and atreporting 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 toend 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 toend reporting.

7/30/2019 FLR 2013

3/5

Modifiers:

Example

Your new patient Will has sought your physical therapy services following a total hip replacement. For this example, wecan establish Wills primary functional limitation as Mobility: Walking & Moving Around. Because this is Wills initialexamination, the corresponding G-code is G8978. Now for the modifier. Appropriate to Wills current condition, youregoing to select the lower extremity functional scalean outcome measurement test (or one like it) that you should beperforming on Will even without this new mandate. Will scores a 5; based on the test scoring rules that means he is at6.25% of maximal functionor 93.75% impairmentwhich corresponds to modifier CM. So, Wills current status on his

7/30/2019 FLR 2013

4/5

initial examination would be G8978 CM GP. Youd want to make sure that this code appears on the claim you submit tobilling for the initial exam.

Now, lets tackle his goal. Youll select G8979, the code under Mobility: Walking & Moving Around that applies to projectedgoal status, and assign to it the CI modifier because you believe that by the end of treatment Will will improve to at least1% but less than 20% impairment. Youd want to make sure that G8979 CI GP also appears on the claim you submit tobilling for the initial exam.

At the tenth visit, Wills G-code remains the same (G8978) and you perform the same outcome measurement tool. As aresult 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 isany change to your goal for Will, his projected goal status code remains the same at G8979 CI GP. Youd want to makesure that G8978 CL GP and G8979 CI GP appear on the billing claim you submit to Medicare for this Progress Note visit.You may notbill the re-evaluation code 97002 just for submitting these codes; you may only bill 97002 if this is truly a re-evaluation.

On the 20th visit, Wills progress is outstanding, and he scores a 75 on the lower extremity functional scale; this meanshes at 93.75% of maximal functionor 6.25% impairmentwhich corresponds to modifier CI. Will has met his goal soyou discharge his primary functional limitation with G-code G8980, the code under Mobility: Walking & Moving Around thatapplies to discharge status (G8980 CI GP). The projected goal status code remains the same at G8979 CI GP. Thesecodes 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, letssay that Will is also experiencing wound healing capacity limitation. This doesnt fall under any of the other functionallimitation 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 theSouth West Regional Wound Care Toolkit and determine he has a 50% wound healing limitation, which corresponds tomodifier CK. Thus, Wills new G-code is G8990 CK GP. This would appear on the billing claim on this 20th visit date ofservice. You can now continue to see Will with wound care as your primary limitation. Treatment and documentation oftreatment must now reflect this primary limitation. As treatment continues for Will, you will repeat the steps listed above atthe 30th visit, 40th visit, etc., through the discharge of the patient.

http://www.thehealthline.ca/libraryContent.aspx?id=231http://www.thehealthline.ca/libraryContent.aspx?id=231http://www.thehealthline.ca/libraryContent.aspx?id=231http://www.thehealthline.ca/libraryContent.aspx?id=231http://www.thehealthline.ca/libraryContent.aspx?id=231

7/30/2019 FLR 2013

5/5

Reader Comments

You're correct in that you can only have one primary functional limitation at a time. If a new functional limitation existsonce 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 l imitation 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 thecorresponding modifier.- Determine the new projected long-term goal based on the current functional limitation status and other patientinformation.

- Find the appropriate G-code and modifier on your billing sheet. If you have integrated billing, these will then passthrough the integration to the appropriate billing software:-Current status with severity modifier-Projected goal with severity modifier