How To Use HCPCS Code G2145

HCPCS code G2145 describes the functional status measured by the Oswestry Disability Index (ODI) version 2.1a at three months (6 – 20 weeks) postoperatively. This code is used when the functional status measured by the ODI version 2.1a is greater than 22 and when the functional status measured by the ODI version 2.1a within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrates an improvement of less than 30 points.

1. What is HCPCS G2145?

HCPCS code G2145 is a specific code used to identify the functional status measured by the Oswestry Disability Index (ODI) version 2.1a at three months (6 – 20 weeks) postoperatively. It is used when the functional status measured by the ODI version 2.1a is greater than 22 and when the improvement of functional status measured by the ODI version 2.1a within three months preoperatively and at three months (6 – 20 weeks) postoperatively is less than 30 points.

2. Official Description

The official description of HCPCS code G2145 is “Functional status measured by the Oswestry Disability Index (ODI) version 2.1a at three months (6 – 20 weeks) postoperatively was greater than 22 and functional status measured by the ODI version 2.1a within three months preoperatively and at three months (6 – 20 weeks) postoperatively demonstrated an improvement of less than 30 points.” The short description is “Fsodi 6-20wk >22 or chg 30pt.”

3. Procedure

1. The provider should administer the Oswestry Disability Index (ODI) version 2.1a questionnaire to the patient.
2. The provider should record the patient’s functional status measured by the ODI version 2.1a at three months (6 – 20 weeks) postoperatively.
3. If the functional status measured by the ODI version 2.1a is greater than 22 and the improvement of functional status measured by the ODI version 2.1a within three months preoperatively and at three months (6 – 20 weeks) postoperatively is less than 30 points, the provider should assign HCPCS code G2145.

4. When to use HCPCS code G2145

HCPCS code G2145 should be used when the patient’s functional status, as measured by the Oswestry Disability Index (ODI) version 2.1a, meets the specific criteria. The functional status must be measured at three months (6 – 20 weeks) postoperatively and be greater than 22. Additionally, the improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively must be less than 30 points.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2145, healthcare providers should ensure that the following documentation is included:

• Record of the patient’s functional status measured by the Oswestry Disability Index (ODI) version 2.1a at three months (6 – 20 weeks) postoperatively.
• Evidence of the functional status being greater than 22.
• Evidence of the improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively being less than 30 points.

6. Historical Information and Code Maintenance

HCPCS code G2145 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of January 01, 2022, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G2145 is determined by carrier judgment, as indicated by the coverage code C. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This could be due to the service not being covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS code G2145 is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G2145 should be billed:

1. Example 1: A patient undergoes spinal surgery and at three months (6 – 20 weeks) postoperatively, their functional status measured by the Oswestry Disability Index (ODI) version 2.1a is 25. The improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively is only 10 points.
2. Example 2: A patient undergoes hip replacement surgery and at three months (6 – 20 weeks) postoperatively, their functional status measured by the Oswestry Disability Index (ODI) version 2.1a is 30. The improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively is only 20 points.
3. Example 3: A patient undergoes knee surgery and at three months (6 – 20 weeks) postoperatively, their functional status measured by the Oswestry Disability Index (ODI) version 2.1a is 20. The improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively is only 5 points.
4. Example 4: A patient undergoes shoulder surgery and at three months (6 – 20 weeks) postoperatively, their functional status measured by the Oswestry Disability Index (ODI) version 2.1a is 28. The improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively is only 15 points.
5. Example 5: A patient undergoes back surgery and at three months (6 – 20 weeks) postoperatively, their functional status measured by the Oswestry Disability Index (ODI) version 2.1a is 23. The improvement in functional status within three months preoperatively and at three months (6 – 20 weeks) postoperatively is only 25 points.