How To Use HCPCS Code G8988

HCPCS code G8988 describes the self-care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is used to indicate the status of the patient’s self-care goals throughout the therapy process. It provides valuable information about the progress and outcomes of the therapy sessions.

1. What is HCPCS G8988?

HCPCS code G8988 is specifically used to identify the self-care functional limitation and the projected goal status of a patient at the beginning of a therapy episode, at reporting intervals, and at discharge or to end reporting. It helps in tracking the progress of the patient’s self-care goals during the therapy sessions.

2. Official Description

The official description of HCPCS code G8988 is “Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting.” The short description for this code is “Self care goal status.”

3. Procedure

1. The provider assesses the patient’s self-care functional limitation at the beginning of the therapy episode.
2. The provider sets projected goals for the patient’s self-care based on the assessment.
3. Throughout the therapy sessions, the provider periodically evaluates and documents the patient’s progress towards the self-care goals.
4. At the end of the therapy episode or reporting period, the provider assesses the patient’s self-care goal status and documents it.

4. When to use HCPCS code G8988

HCPCS code G8988 should be used when reporting the self-care functional limitation and the projected goal status of a patient at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. It is important to use this code accurately to provide a comprehensive picture of the patient’s progress and outcomes during therapy.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8988, healthcare providers need to document the patient’s self-care functional limitation assessment, the projected goals, and the periodic evaluations of the patient’s progress towards those goals. The documentation should be detailed and support the medical necessity of the therapy services provided.

6. Historical Information and Code Maintenance

HCPCS code G8988 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has a coverage code of C, which indicates that carrier judgment is used to determine coverage. The code has an action code of N, meaning no maintenance for this code. The code was terminated on December 31, 2019.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G8988 may vary. It is important to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that it is not applicable as HCPCS is not priced separately by Part B.

8. Examples

Here are five examples of when HCPCS code G8988 should be billed:

1. A patient with a self-care functional limitation due to a recent stroke undergoes therapy sessions to improve their ability to perform daily self-care activities. The provider assesses the patient’s self-care goal status at the beginning of the therapy episode and periodically evaluates their progress towards the goals.
2. A patient with a chronic condition that affects their self-care abilities receives therapy sessions to maintain and improve their self-care skills. The provider assesses the patient’s self-care goal status at the therapy episode outset and documents their progress throughout the reporting intervals.
3. A patient with a musculoskeletal injury undergoes therapy sessions to regain their self-care abilities. The provider sets projected goals for the patient’s self-care and evaluates their progress at the reporting intervals and at discharge.
4. A patient with a cognitive impairment receives therapy sessions to enhance their self-care skills. The provider assesses the patient’s self-care goal status at the beginning of the therapy episode and periodically evaluates their progress towards the goals.
5. A patient with a developmental disability undergoes therapy sessions to improve their self-care abilities. The provider assesses the patient’s self-care goal status at the therapy episode outset and documents their progress at the reporting intervals and at discharge.