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G2211 and RAF score

J

JDACPC

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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
 
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?
 
jmjansen said:
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?
Click to expand...
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.
 
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?
 
miriambroyles said:
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?
Click to expand...
You would never bill G2211 alone. The E/M is what risk adjusts on a claim, not the G2211. For Risk adjustment, the type of service as well as the quality of documentation matter. G2211 might be billed on a risk adjustable eligible claim, but is is not a service that alone risk adjust. Risk adjustment is more about documentation quality and ICD 10 code support on specific list of encounter types vs the CPTS billed to a claim. As long as your claim has at least one risk eligible CPT, you are good to go.
 
jmjansen said:
You would never bill G2211 alone. The E/M is what risk adjusts on a claim, not the G2211. For Risk adjustment, the type of service as well as the quality of documentation matter. G2211 might be billed on a risk adjustable eligible claim, but is is not a service that alone risk adjust. Risk adjustment is more about documentation quality and ICD 10 code support on specific list of encounter types vs the CPTS billed to a claim. As long as your claim has at least one risk eligible CPT, you are good to go.
Click to expand...

That was my point. G2211 is not acceptable by CMS for risk adjustment. But, since it is not used alone, the E/M code G2211 is added to likely is an acceptable CPT (E/M) for risk adjustment. The CPT code does not risk adjust but the ICD10 codes must be for a visit that is an acceptable type of visit or acceptable CPT (E/M) for the associated ICD10 codes to risk adjust. G2211 will not impact the acceptability for RAF. The corresponding E/M will.
 
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