Wiki G2211 and RAF score

[JDACPC]

Does anyone know if the diagnoses on G2211 billings affect RAF score for providers billing? Internet/AI says yes, but I need some type of proof from authoritative guidance, and I am not having any luck.

TIA

 

[jmjansen]

DXs impact RAF score. Since this can't be billed as a stand alone CPT and requires E/M, the question should be if the EM associated with the add on code is applicable for risk adjustment and then if the documentation supports any HCC billed for that E/M.

Could you clarify your question?

 

[JDACPC]

DXs impact RAF score. Since this can't be billed as a stand alone CPT and requires E/M, the question should be if the EM associated with the add on code is applicable for risk adjustment and then if the documentation supports any HCC billed for that E/M.

Could you clarify your question?

Thank you for your response. It's been found that the E&M and G2211 diagnoses do not always match, i.e. the E&M will have all pertinent dx but the G2211 was only associated with the "serious complex condition." The question was thrown out there whether these needed to be corrected to match diagnoses and if not having all associated diagnoses on the E&M AND G2211 affects the RAF score.

 

[jmjansen]

For what it is worth, G2211 is not an applicable CPT code for risk adjustment with 2025 DOS.

https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors-items/cpt-hcpcs

I wold be asking-
Is the "serious complex condition" addressed with MEAT/TAMPER/DSP within the encounter notes by a risk provider?

 

[JDACPC]

For what it is worth, G2211 is not an applicable CPT code for risk adjustment with 2025 DOS.

https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors-items/cpt-hcpcs

I wold be asking-
Is the "serious complex condition" addressed with MEAT/TAMPER/DSP within the encounter notes by a risk provider?

That answers that. Thank you SO much!!

 

[miriambroyles]

G2211 alone is not on the list as an applicable CPT code for risk adjustment. However, it is an add-on code. So, the E/M code G2211 is added on to likely is an applicable CPT code for risk adjustment... Right?