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Billing Updates | G-Codes and C-modifiers for chiropractors working with PTs

 In chiropractic billing, chiropractic software system updates, medical billing

Genesis’ Vericle billing platform has been updated with G-Codes and C-modifiers to improve compliance for all clients who work with a physical therapist in their chiropractic clinics.

Medicare is now requiring that G-Codes and C-modifiers are included on your physical therapy claims and documentation. This change is very complex and can not be done from memory alone. If these requirements are not met, providers will not get paid by Medicare and these claims will be denied.

The G-Codes are used on your Initial Evaluations, Progress notes/Re-evals and Discharge visits to track the patient’s progress in reaching their goals. These codes are used to demonstrate medical necessity and ensure that the patient is getting better. In addition to billing out these G-Codes, providers also have to add C-modifiers depending on the severity of the patient’s condition. Providers also need to use these codes in their documentation and ensure that it is supported with functional testing (e.g., Dash, Tinetti, etc). Any claims submitted after July 1, 2013 that do not have G-Codes on the required visits will be denied. If these findings are not documented, the audit risk increases significantly.

G-Codes and C-modifiers have been added to all procedures for clinicians with the PT, OT, and/or SLP specialty code. These can be found in the Procedures list on the Billing and EHR screen. We have put in several validations that will flag any claim missing the G-Codes and C-modifiers. These claims will be sent back to your provider workbench for review. We have also created a new XDoc template that allows providers to document the Initial Evaluation, Progress Note, and Discharge Summary all in one XDoc template so they will be able to track the overall progress of the patient. This template also has the Functional Assessment Tools (e.g., Dash, Tinetti, etc) complete with automatic calculations to support your G-Code and C-Modifier reporting. To add this XDoc template to your account, please open a Vericle ticket to your SPOC.
We have held two G-codes webinars on these updates this month and will be publishing a downloadable version in the next couple weeks. If you have any questions or concerns regarding these new requirements, please do not hesitate to open a Vericle ticket to your Coach.
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