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  • Functional Limitation Reporting vs PQRS: Understanding the Differences

    APTA has posted a new chart to help members understand the differences between the Physician Quality Reporting System (PQRS) program and a congressionally mandated functional limitation reporting program that begins January 1, 2013. The chart can be found on APTA's Functional Limitation Reporting Under Medicare webpage.

    The Middle Class Tax Relief Act of 2012 mandated that the Centers for Medicare and Medicaid Services (CMS) begin functional limitation data collection on January 1, 2013, for Medicare beneficiaries. The new functional limitation reporting will be done through nonpayable G-codes that are similar in their appearance to PQRS quality data codes. The functional limitation reporting will be visit-driven and must be completed on evaluation, every 10th visit, and at discharge. All practice settings that provide outpatient therapy services must include this information on the claim form. Specifically, the policy will apply to physical therapy, occupational therapy, and speech-language-pathology services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and nonphysician practitioners.

    Simultaneously, attention is increasing on PQRS as the program changes from an incentive-based program to a penalty program, with the 2013 year being pivotal to the program's changeover, informing both the 2013 bonus and the 2015 penalty. PQRS, the quality reporting program for Medicare Part B, was implemented in 2007. Physical therapists are eligible professionals in this reporting program and can report a variety of measures, including pain assessment on initial evaluation and a measure related to the use of a functional assessment tool. Reporting under the PQRS program is tied to CPT codes. Therapists reporting under this program submit quality data codes for the selected measures with CPT code 97001 and sometimes with 97002.


    • Is there information about whether the ICD-9 codes (diagnosis codes) need to be reported only one at a time according to which "functional limitation" is being reported?

      Posted by Dawn Standley on 12/14/2012 1:27 PM

    • From reading the above I am not seeing the differences and am confused as to where to find the codes for the PQRS

      Posted by Sue Jeffrey on 12/14/2012 1:58 PM

    • This has got to be the most frustrating thing to figure out!I have listened to a webinar and read all the documents.Is there a quick guide all inclusive of all the documents that shows the G-codes,measures,modifiers,therapy modifiers,severity modifiers,etc.,etc.,etc.,that outlines when to code what code to what code to give what modifier to a code each time???

      Posted by Karen Bonsack -> >FX^C on 12/14/2012 2:15 PM

    • CMS.gov has good documents to explain and quick reference charts. http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/FunctionalReportingNPC.pdf

      Posted by Melanie on 12/14/2012 4:49 PM

    • Medicare has finally succeeded in making things complicated enough that you can't figure it out on your own. You'll need a team of billing experts helping you, but even then you'll never be able to remember what codes to include and when unless your EHR and billing are integrated and set up to automate the process for you. If you're still documenting on paper now's the time to change. Check out Systems4PT if you need a system that can automate it for you. They're PQRS compliant.

      Posted by Jason Myers on 12/14/2012 5:00 PM

    • I just want to thank you for clarifying and simplifying this mess. The webinar was quite confusing and you were able to outline this as they were not. This is why we are members of the APTA!!!

      Posted by Deborah Cook -> =HR\@L on 12/14/2012 5:20 PM

    • Could somebody suggest any free functional outcome measures that may be used without having to spend a fortune.

      Posted by Jaya Gurnani on 12/16/2012 2:08 PM

    • Will CORFS be required to do PORS?

      Posted by Todd on 12/21/2012 3:04 PM

    • Any information on whether we will be required to do the PQRS type reporting on part B patients in SNFs? Currently I think we are excluded institutional providers, correct?

      Posted by Carol Ramsey -> =KS\< on 12/27/2012 7:10 PM

    • Jaya: the OPTIMAL instrument is available for free via the APTA and is an accepted measure for PQRS reporting and tracking/utilization for functional coding purposes.

      Posted by Greg Given on 1/9/2013 10:52 PM

    • Quick-DASH is a good reporting tool for upper extremity limitations and free.

      Posted by Dale on 8/29/2013 6:56 PM

    • I am thoroughly confused!! I was under the impression that for Physical therapy billing we only had to document the functional status G-codes, NOT the PQRS also. is it mandatory to bill the PQRS with the eval or optional

      Posted by Gina on 2/13/2014 4:35 PM

    • How can I get utilization data report of functional G codes since implementation by Medicare?

      Posted by Dennise Monserrate on 8/13/2017 5:55 PM

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