Wiki G2211 Defined - Anyone Have Examples?

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kbrandt101

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G2211 is the new code for “Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).”
Additionally: “This proposed valuation accounts for the additional work resource costs associated with furnishing primary care that distinguishes E/M primary care visits from other types of E/M visits and maintains work budget neutrality across the office/outpatient E/M code set."

So what qualifies as complexity inherent? I understand that it's for long term chronic conditions but what would need to be documented to support the coding/use of G2211? Can someone provide clarification or context to best understand when this code should be applied above and beyond the Office Visit?
 
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SharonCollachi said:
The visit note itself is the documentation. If you have a patient with diabetes and copd, they are going to be complex. If you have a patient with an upper respiratory infection, that you see once for that condition, it's not complex.

Look at the final rule here (use Ctrl-F to search for G2211): https://public-inspection.federalregister.gov/2020-26815.pdf
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Thank you Sharon. That article was most helpful.

For anyone also looking for the answer to the G2211 support, I found my response with this section:

"We continue to believe that the time, intensity, and PE involved in furnishing services to patients on an ongoing basis that result in a comprehensive, longitudinal, and continuous relationship with the patient and involves delivery of team-based care that is accessible, coordinated with other practitioners and providers, and integrated with the broader health care landscape, are not adequately described by the revised office/outpatient E/M visit code set. We believe the inclusion of HCPCS add-on code G2211 appropriately recognizes the resources involved when practitioners furnish services that are best-suited to patients’ ongoing care needs and potentially evolving illness." link: https://public-inspection.federalregister.gov/2020-26815.pdf

Since a lot of the clients I work with do see chronic care patients, what we'd be looking for are the team-based care and care coordination components rather than just another refill visit. This will definitely help with when to apply that code.
 
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How are practices handling insuring this is being billed and correctly? My Providers will never remember to bill - we do charge write back- charges import directly into our PM system from EMR-
Thanks
 
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My providers (Endocrinologist) are interested this code. I realize that it will not be implemented until 2024 but I wonder how often can we use this code? At every visit? I do not see a frequency issue.
 
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REllington11 said:
My providers (Endocrinologist) are interested this code. I realize that it will not be implemented until 2024 but I wonder how often can we use this code? At every visit? I do not see a frequency issue.
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Medicare indicated that they expected specialists would be using it at every, or nearly every visit.
 
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RE: G2211. Now that it is a covered service through Medicare (and a few commercial carriers), here are my questions: For those carriers that do not recognize this code, is it being rejected as non-covered (the patient’s responsibility) or non-allowed (the patient may not be billed for the charge)? In addition, is there an RVU associated with this code? Finally, with 99211 reserved for nursing visits, would you consider it appropriate to use this code when there is an ongoing relationship with an allergist, as the patient is scheduled to come in regularly for allergy shots?
 
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nancyharty said:
RE: G2211. Now that it is a covered service through Medicare (and a few commercial carriers), here are my questions: For those carriers that do not recognize this code, is it being rejected as non-covered (the patient’s responsibility) or non-allowed (the patient may not be billed for the charge)? In addition, is there an RVU associated with this code? Finally, with 99211 reserved for nursing visits, would you consider it appropriate to use this code when there is an ongoing relationship with an allergist, as the patient is scheduled to come in regularly for allergy shots?
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1) I have not seen any denials with patient responsible. I have seen bundling denials. Also, for patients with deductible/co-insurance, they may owe for G2211.
2) RVUs are available several places. Any online encoder, some CPT books, and CMS all publish this information. The national total RVU is .49 with geographic adjustments.
3) My interpretation of G2211 leads me to believe it is NOT appropriate if the physician is not even seeing the patient for this encounter. While 99211 MAY be billed with G2211, I would be hard pressed to think of scenario that would apply. For example, when a patient presents for allergy shots, you would typically code the allergy shot an not an E&M service. If there were a significant and separately identifiable E&M, that would be with the physician/ACP, and would require -25. Once you have -25 on the E&M, G2211 no longer applies.
 
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