Wiki G2211- Add On Code

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Adrienne_Pearce94@yahoo.com

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Hi, I work for a primary care office and I am currently a new student at APPC and I wanted to make sure that I am understanding how the G2211 add on code works.
I have been working the A/R and have been seeing denials come back on G2211.
for example:
99214,25
G2211
87804
87804,59
87426
87880

G2211 denied and is bundled.
My question is...can G2211 be billed with in house testing's? 87804,87426,81002,87880?
and can G2211 be billed with a 7-14day TOC?
 
Adrienne_Pearce94@yahoo.com said:
Hi, I work for a primary care office and I am currently a new student at APPC and I wanted to make sure that I am understanding how the G2211 add on code works.
I have been working the A/R and have been seeing denials come back on G2211.
for example:
99214,25
G2211
87804
87804,59
87426
87880

G2211 denied and is bundled.
My question is...can G2211 be billed with in house testing's? 87804,87426,81002,87880?
and can G2211 be billed with a 7-14day TOC?
Click to expand...
Code G2211 is applicable when the primary care physician who has or is establishing a longitudinal relationship with the patient provides an office E/M like 99214 but, G2211 is only paid when modifier 25 is appended to the E/M code due to reporting a preventive service covered by Medicare (eg, annual wellness visit) in addition to the office visit. That said, the question is whether modifier 25 is required by the individual plans when reporting an E/M service and laboratory tests (not bundled by NCCI). Because G2211 applies to so many office visits provided by family physicians, denial due to misapplication of modifier 25 could amount to significant loss of revenue. I hope that is helpful. Cindy
 
Cynthia Hughes said:
Code G2211 is applicable when the primary care physician who has or is establishing a longitudinal relationship with the patient provides an office E/M like 99214 but, G2211 is only paid when modifier 25 is appended to the E/M code due to reporting a preventive service covered by Medicare (eg, annual wellness visit) in addition to the office visit. That said, the question is whether modifier 25 is required by the individual plans when reporting an E/M service and laboratory tests (not bundled by NCCI). Because G2211 applies to so many office visits provided by family physicians, denial due to misapplication of modifier 25 could amount to significant loss of revenue. I hope that is helpful. Cindy
Click to expand...
This was very helpful. Thank you Cindy for the response. I do appreciate it.
 
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