Wiki G2211 questions

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Martini

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Hi there - I have two questions for the group on G2211. These are from providers.
1. Does billing for a fingerstick blood glucose as a separate code require a 25 modifier be appended to the E/M service, and hence G2211 would not be allowed?
2. Is treating someone with osteoporosis and fracture considered ongoing care of a serious condition. Is this excluded the same way insulin is excluded in E/M medical decision making from being “drug therapy requiring intensive monitoring”?

Thank you.
 
Hi there -
1. If you don't have a claims history for how you've reported the fingerstick in the past, check the NCCI edits.
2. Short answer: I think so.
Longer answer: Remember that according to the descriptor, the care can be related to a serious or complex condition. I haven't seen a list of conditions that CMS has specifically excluded from coverage and I don't expect one. So far CMS has given two examples of serious/complex conditions: HIV and sickle cell anemia. CMS has said it will issue more examples but will not issue a comprehensive list. Whether a specific patient's condition is serious or complex should be reflected in the chart. The other factor will be whether the provider is performing ongoing care for the patient, versus few encounters for an acute condition.

If you haven't shared it with them already, CMS published a couple of examples in the final 2024 physician fee schedule that it also released in a MLN article https://www.cms.gov/files/document/...anagement-visit-complexity-add-code-g2211.pdf. Your Medicare administrative contractor may have issued more guidance and these would be great questions to take to their next Ask the Contractor Call.

My opinion, based on what I know today, Feb. 13, 2023 2024, is providers should not think in terms of certain diagnoses that will always (or never) be serious or complex and instead focus on their relationship with the patient and the specific patient's condition.
 
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Thank you for the link to the article. That was a big help to me with my questions. sj
 
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