Q/A: MIPS and G Codes

by  Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
Aug 24th, 2017 - Reviewed/Updated Feb 5th

Question

We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good? All of our doctors are diligent about using outcome assessment tools. Here is what we currently do: -Quadruple Analog Scale- at the initial visit, every 30 days, re-exaccerbations, final exams. -Oswestrys- at the initial visit, re-exaccerbations, final exams. Is this what you would recommend continuing with, or is it overkill and unnecessary for our doctors who do not qualify for MIPS to be doing an outcome assessment (quadruple analog scale) every 30 days?

Answer 

It will not do any harm to report G codes even if the practice/provider doesn't need to. It could be somewhat overkill for those doctors that do not qualify for MIPS. However, note that Medicare is extremely strict on medical necessity guidelines and in the event one of these doctors receive medical necessity denials or records requests, these additional bits of documentation will be extremely valuable to you in supporting medical necessity and thus either not have to pay Medicare back due to their own audit findings or not getting claims denied that you are expecting payment for.

About Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Brandy is a Certified Professional Coder (CPC), Certified Medical Compliance Officer (CMCO), ChiroCode Certified Chiropractic Professional Coder (CCCPC), a Certified Professional Compliance Officer (CPCO)and a Certified Professional Medical Auditor (CPMA). She is also the President of CHelpDesk Solutions (www.CHelpDesk.com), chiropractic's on-demand Certified Virtual Chiropractic Assistant.

Brandy is a member of the AAPC (American Academy of Professional Coders), PMI (Practice Management Institute), and the ACA (American Chiropractic Association).