Page 208 - Medicare Benefit Policy Manual

treatment. When the beneficiary has more than one functional limitation, the clinician
may need to make a determination as to which functional limitation is primary. In these
cases, the clinician may choose the functional limitation that is:

• Most clinically relevant to a successful outcome for the beneficiary;

• The one that would yield the quickest and/or greatest functional progress; or

• The one that is the greatest priority for the beneficiary.
In all cases, this primary functional limitation should reflect the predominant limitation
that the furnished therapy services are intended to address.

For services typically reported as PT or OT, the clinician reports one of the “Other
PT/OT” functional G-codes sets to report when one of the four PT/OT categorical code
sets does not describe the beneficiary’s functional limitation, as follows:

• a beneficiary’s functional limitation that is not defined by one of the four
categories;

• a beneficiary whose therapy services are not intended to treat a functional
limitation; or

• a beneficiary’s functional limitation where an overall, composite, or other score
from a functional assessment tool is used and does not clearly represent a
functional limitation defined by one of the above four categorical PT/OT code
sets.

In addition, the subsequent “Other PT/OT” G-code set is only reported after the primary
“Other PT/OT” G-code set has been reported for the beneficiary during the same episode
of care.

For services typically reported as SLP services, the clinician uses the “Other SLP”
functional G-code to report when the functional limitation being treated is not represented
by one of the seven categorical SLP functional measures. In addition, the “Other SLP”
G-code set is used to report where an overall, composite, or other score from an
assessment tool that does not clearly represent a functional limitation defined by one of
the seven categorical SLP measures.

B. Selecting the severity modifiers to use in functional reporting/documenting.

Each G-code requires one of the following severity modifiers. When the clinician reports
any of the following a modifier is used to convey the severity of the functional limitation:
current status, the goal status and the discharge status.

Modifier Impairment Limitation Restriction
CH 0 percent impaired, limited or restricted