Functional data reporting is required on home health outpatient claims (type of bill 34X).  For assistance, the following chart illustrates when reporting is required and what G-codes would be used for the scenario in which a beneficiary has two functional limitations at the outset of the therapy episode. The therapist reports the mobility one first. The second functional limitation is not defined by any of the other 3 categorical G-code sets.

Tip:  For every ‘Current’ or ‘Discharge’ status, you also need the ‘Goal’ status.

Resources:

· CMS “Functional Reporting” Web page

· Preparing for Therapy Functional Reporting implementation in CY 2013 National Provider Call

· CGS “Home Health Outpatient Therapy Billing” Web page

· Medicare Claims Processing Manual, Pub. 100-04, Ch. 5, §10.6