Wiki G2211- HELP!

[sjack]

A provider has asked me to find out what the new G2211 code entails. What are the limitations? Who can bill it? How often? I was able to find the Medicare allowable rate of $16.05 and I can read the description in the coding book, but it does not tell me if mid-levels are eligible to bill this code or Physicians only. Can it be billed on each visit where chronic or serious conditions are addressed or is there a limit on the number of times it can be billed? I understand that it is not billable with wellness, transitional care management, care plan oversight etc... but what else do I need to know to confidently use this code for my providers? I have scoured the webinar page and do not see anything that will address my questions. Is anyone using this code? Are you seeing success? Any insight would be appreciated.

 

[sjack]

I was able to find the link to this article in another question thread and wanted to post it here, in case other have questions as well.

Here you go and thanks to the person who posted this link.

https://www.cms.gov/files/document/mm13473-how-use-office-and-outpatient-evaluation-and-management-visit-complexity-add-code-g2211.pdf

 

[jkyles]

A provider has asked me to find out what the new G2211 code entails. What are the limitations? Who can bill it? How often? I was able to find the Medicare allowable rate of $16.05 and I can read the description in the coding book, but it does not tell me if mid-levels are eligible to bill this code or Physicians only. Can it be billed on each visit where chronic or serious conditions are addressed or is there a limit on the number of times it can be billed? I understand that it is not billable with wellness, transitional care management, care plan oversight etc... but what else do I need to know to confidently use this code for my providers? I have scoured the webinar page and do not see anything that will address my questions. Is anyone using this code? Are you seeing success? Any insight would be appreciated.

Hi there, I highly recommend the link posted above. Some quick answers:
1. The code can be reported by any provider who can bill office/outpatient E/M visits under their own name/NPI.
2. There's no limit, but the documentation for each visit must meet the requirements for the code.
3. It can only be reported with office/outpatient visits (99202-99215).
4. The documentation must clearly show that the patient/provider relationship meets the code's requirements.

 

[amyjph]

There is so much information on this...

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html

https://www.aafp.org/advocacy/advocacy-topics/physician-payment/medicare/advocacy-focus-g2211.html

https://codingintel.com/hcpcs-add-on-code-for-e-m-visit-complexity/

https://www.aapc.com/blog/89677-when-is-it-time-to-use-g2211/

What is your practice specialty?

 

[rachaelwilleford]

Throwing this one out there too: https://society.asco.org/sites/new-...ments/2024-01-Visit-Complexity-AddOn-Code.pdf

 

[vidraj]

Hi there, I highly recommend the link posted above. Some quick answers:
1. The code can be reported by any provider who can bill office/outpatient E/M visits under their own name/NPI.
2. There's no limit, but the documentation for each visit must meet the requirements for the code.
3. It can only be reported with office/outpatient visits (99202-99215).
4. The documentation must clearly show that the patient/provider relationship meets the code's requirements.

Anyone billing this for Specialists? (I am looking for Cardiology, Nephrology in specific)

• Can you elaborate a little more on this? - "Documentation for each visit must meet the requirements for the code, The documentation must clearly show that the patient/provider relationship meets the code's requirements". Do they need to add any note under their plan?