How To Use HCPCS Code G8994

HCPCS code G8994 describes a specific type of physical or occupational therapy subsequent functional limitation. This code is used to indicate the projected goal status at the beginning of a therapy episode, as well as at reporting intervals and at discharge or to end reporting. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for these therapy services.

1. What is HCPCS G8994?

HCPCS code G8994 is a specific code used to identify other physical or occupational therapy subsequent functional limitation. It is important to note that this code was terminated on December 31, 2019, and is no longer in use. However, it is still valuable to understand its meaning and usage for historical purposes.

2. Official Description

The official description of HCPCS code G8994 is “Other physical or occupational therapy subsequent 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 “Sub pt/ot goal status.”

3. Procedure

1. At the beginning of a therapy episode, the provider assesses the functional limitation of the patient.
2. The provider establishes projected goal status for the patient’s therapy.
3. Throughout the therapy episode, the provider periodically evaluates and reports the patient’s progress towards the projected goal status.
4. At the end of the therapy episode or when reporting ends, the provider documents the final goal status achieved by the patient.

4. When to use HCPCS code G8994

HCPCS code G8994 should be used in the context of physical or occupational therapy when documenting and reporting the projected goal status of the patient. It is used to indicate the functional limitation at the beginning of the therapy episode, as well as the progress made towards the projected goal status throughout the therapy.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G8994, healthcare providers need to ensure that they document the functional limitation at the therapy episode outset, the projected goal status, and the progress made towards the goal at reporting intervals. It is important to provide detailed and accurate documentation to support the medical necessity of the therapy services.

6. Historical Information and Code Maintenance

HCPCS code G8994 was added to the Healthcare Common Procedure Coding System on January 1, 2013. It was terminated on December 31, 2019. The termination of this code means that it is no longer valid for billing purposes. It is important for medical coders to stay updated with the current codes and guidelines to ensure accurate documentation and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance coverage for HCPCS code G8994 may vary. It is important for healthcare providers to check with the specific payer for coverage and reimbursement guidelines. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value is not established or applicable for this code.

8. Examples

Here are some examples of scenarios where HCPCS code G8994 may have been used:

1. A patient with a functional limitation in their upper extremities undergoes physical therapy to improve range of motion and strength. The projected goal status at the beginning of the therapy is to regain full range of motion and strength in the affected areas. Throughout the therapy, the patient shows progress towards the goal, and at the end of the therapy, they achieve the projected goal status.
2. A patient with a functional limitation in their lower extremities receives occupational therapy to improve mobility and independence. The projected goal status at the beginning of the therapy is to be able to walk without assistance and perform daily activities without difficulty. Throughout the therapy, the patient makes progress towards the goal, and at the end of the therapy, they achieve the projected goal status.
3. A patient with a functional limitation in their spine undergoes physical therapy to reduce pain and improve flexibility. The projected goal status at the beginning of the therapy is to decrease pain levels and increase range of motion. Throughout the therapy, the patient shows progress towards the goal, and at the end of the therapy, they achieve the projected goal status.
4. A patient with a functional limitation in their hand receives occupational therapy to regain fine motor skills after a hand injury. The projected goal status at the beginning of the therapy is to regain full functionality and dexterity in the hand. Throughout the therapy, the patient makes progress towards the goal, and at the end of the therapy, they achieve the projected goal status.
5. A patient with a functional limitation in their lower back undergoes physical therapy to improve core strength and reduce pain. The projected goal status at the beginning of the therapy is to be able to perform daily activities without experiencing lower back pain. Throughout the therapy, the patient shows progress towards the goal, and at the end of the therapy, they achieve the projected goal status.