G-Codes and Lymphedema

(The information below is to the best of our knowledge. This new reporting system is a ‘work in progress’ and is still evolving.) 

What g-code set should I use?

You are not limited to one set of codes. The codes designated as ‘other’ and ‘subsequent other’ were set up for lymphedema and wound care, but you should use whatever code is the most appropriate. Start out with worst problem the patient has and use that set of codes first. If ADL’s are the biggest problem, then use the ‘ADL’ codes. If mobility is the biggest problem, use the ‘mobility’ codes. 

If swelling is the biggest problem, then use the ‘other’ code

G8990 - current status
G8991 - goal status
G8992 -  d/c status

If you reach the goal for the first “other” set, you may then use the “subsequent other” set

G8993 - current status
G8944 - goal status
G8995 - d/c status

If you reach the goal for one set of codes, you can start using another set.

Note: you do not have to only treat the one problem reported on the g-codes, you will treat your patient as you normally do. You simply have to report one g-code at a time, starting with the most important.

How many g-codes do I use at a time?

You may only report one SET at a time. Each set has three codes (current/goal/d/c status.)

Eval only = use all three. If you are only going to do an evaluation (no treatment) then you will use all three codes in the set.

Otherwise you must enter two of the set each time you report.

Current status - used at therapy outset and at each reporting interval
Goal status - used every time
D/C status - used at discharge (or end of treatment)

Bottom line:  you should always report at least two (from the same set.)

What functional measures should I use?

You do not HAVE to use a functional measure specific to lymphedema for the g-codes.

You should continue to use those measures recommended by your employer. A brief survey of our affiliate members shows that many lymphedema therapists are using the LEFS for lower extremity lymphedema and the DASH or the for upper extremity lymphedema.

The NLN is currently working with other associations to provide information on current lymphedema assessment tools.

How do I transfer the functional measurements to the g-code modifiers?

The easiest way is to go to http://www.mediserve.com/resource/analysis/cbor-conversion. They have a program that will compare a functional measure code to a G-code modifier. Remember, CMS wants you to use your clinical judgment. You need to justify, in writing, why you selected the modifier you did. Your facility should provide further guidance to you on this. 

When determining which modifier to use, do I consider what kind of adaptive equipment the patient has?

The NLN cannot advise you on that. CMS does not specify whether you should report your patient’s impairment status with or without AE. (Logic would dictate that you would report how well they are doing using whatever equipment they have on the date you file the report.) Once again, your facility will decide that for you. 

It would be best for everyone to be consistent and we hope CMS will respond to this question.

I am an independent practitioner, how do I get hold of these functional measures?

Contact your professional association (AOTA, APTA) 

Are you sure these answers are correct?

Not completely. As stated before, these new procedures are new and will be modified as time goes on. Feel free to write me with any recommendations.

Please e-mail questions or comments to DebraDaugherty [at] TexasHealth.org.">DebraDaugherty [at] TexasHealth.org.