Wiki G2211

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luvbuix

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I am an auditor for an oncology practice. Ever since we implemented G2211 as a billable code 2 years ago some of our providers are afraid to bill it because they feel like we don't qualify & we're committing fraud. I have educated them to death for 2 years with definitions, cheat sheets, & reports all to no avail. What is the best way to report this out so that we can show them it's ok to bill? Are there any national stats out there to show billing rates vs payment rates? I know there aren't many guidelines for it & the few we have are subjective. Any tips would be most appreciated- thanks!!
 
Hi there, Part B claims data for 2024 (the first year Medicare listed it as an Active code) will be available later this year.

Have you checked ASCO? They have information about how to report it, and seeing guidance from a specialty medical society might calm your providers' fears.
 
For oncology, G2211 seems like a no-brainer for any cancer patient with ongoing care. To me, it's right in the description of the code.
G2211 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)

Note it is AND/OR. So reworded, visit complexity inherent to E/M associated with medical care that is part of ongoing care related to a single, serious condition. Obviously cancer is a serious condition. Unless you are discharging the patient, or otherwise no longer following them, it is very appropriate. I would ask the provider why they believe they "don't qualify."

In addition to ASCO, SGO also has some info about using G2211.
 
It's true that a lot of people seem to miss the second condition in the descriptor. Maybe the solution is as easy as printing out the full descriptor and highlighting and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.
:)
 
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