How to Complete Functional Limitation Reporting with Multiple Diagnoses under a Single Plan of Care

Written by Erica Cohen on February 2, 2014

This summer, CMS made functional limitation reporting (FLR) mandatory for all therapists who bill for outpatient services under Medicare Part B and wish to receive reimbursement. Hopefully by now you know how this works (if not, check out this blog post), and it should be relatively simple?in theory, at least. But in practical application, there have been more than a few puzzling one-off situations. Today, let’s talk specifically about functional limitation reporting with multiple diagnoses under a single plan of care based on this APTA podcast. (Check back next week to learn about functional limitation reporting with multiple plans of care.)

Multiple Diagnoses under a Single Plan of Care

According to the APTA, when a therapist treats a patient under a single plan of care, and that patient presents with a referral from the same physician for a second diagnosis, the therapist typically modifies the original plan of care and adds the new diagnosis. Then, the therapist performs a re-evaluation to collect information on the new diagnosis and reports functional limitation data on whichever diagnosis is the patient’s primary functional limitation. If the patient’s first diagnosis is still his or her primary functional limitation, then the therapist reports on that limitation at the time of the re-evaluation. However, if the the patient’s second diagnosis is now his or her primary functional limitation, then the therapists ends reporting on the first primary functional limitation at the time of the re-evaluation and begins reporting the new primary functional limitation on the patient’s next visit.

Podcast Example:

Patient X is a 70-year-old, right-handed man who missed a step at home approximately two weeks ago, catching himself on a railing and sustaining a right-shoulder rotator cuff injury.

  • On July 1, 2013, he has an initial evaluation, at which time his therapist determines that his primary functional limitation is carrying, moving, and handling objects.

    • Patient X is 55% limited, and the therapy goal is to decrease his functional limitation to 10%.

    • The therapist reports G8984 with the CK modifier and G8985 with the CI modifier.

  • On the sixth visit, the patient presents with a new therapy referral from the same physician for neck pain. The therapist performs a reevaluation and determines that carrying, moving, and handling objects is still the patient’s primary functional limitation.

    • The therapist reports G8984 with the CJ modifier, reflecting improvements in the primary functional limitation, and G8985 with the CI modifier.

  • The G-code reporting restarts the visit count, making the next interim reporting interval on or before the 16th visit (ten visits from the sixth visit).

If upon re-evaluation, the therapist determined that Patient X’s primary functional limitation was self-care (associated with his neck pain diagnosis), not carrying, moving, and handling objects, then:

  • On that sixth visit, the therapist would have reported G8986 with the CJ modifier—reflecting end of reporting for his first primary functional limitation—and G8985 with the CI modifier.

  • On the next (seventh) visit, the therapist would have started reporting on the subsequent functional limitation of self-care by reporting G8987 with the CJ modifier and G8988 with the CI modifier.

  • The next reporting interval would be on or before the 17th visit.

For more FLR resources, check out the APTA’s FLR page. If you’re an APTA member and you have a question about FLR, you can contact the association directly at 800-999-2782, ext 8511, or at advocacy@apta.org. If you’re not an APTA member, but you still have questions—or if you just feel like asking us instead—email functionallimitation@webpt.com.

Posted Under: Functional Limitation Reporting
About Erica Cohen

Erica Cohen is a writer and editor with experience in both the healthcare and technology industries. After graduating summa cum laude from Arizona State University, Erica obtained her Master of Arts from the University of Chicago in Social Science. She currently runs her own writing company in San Francisco, California. For questions about functional limitation, please email functionallimitation@webpt.com.