Wiki G2211

[drbarnes]

Hello, I’m new to family practice coding and still learning hands-on to truly understand it.

I’ve read through the guidelines, but I’m still unclear on when it’s appropriate to assign G2211. Is this code only used for Medicare chronic patients when the total time exceeds 60 minutes (e.g., 75 minutes with 99215), or can it be used in other situations that justify ongoing or continuous care?

Example: I have a Medicare patient who comes in for chronic condition follow-up and medication refills. The patient is stable with no new complaints, and the provider spent about 30 minutes with the patient (99214) The provider would like to assign G2211 with this visit.

I want to ensure we receive proper reimbursement while also making sure we are fully compliant with CMS guidelines.
Can anyone help clarify when it’s appropriate to use this G code?

 

[Pam Warren]

G2211 is not a time-based code, and time is never a factor for this code. You're confusing this code with G2212 which is for prolonged services. G2211 is to be reported for Medicare patients (some commercial payers cover, but not many) to identify the long-term care relationship in place (or expected to be in place) for patients with chronic conditions. CMS has a great deal of information on this; but they don't give a lot of documentation examples. I would encourage you to read anything from CMS, AAPC, and NAMAS regarding this code; there is a lot of information out there, so it's not impossible to become a subject matter expert. Only reference reliable sources (stay away from blogs and consultant sites).
Overall, if the patient has a chronic condition(s), and the provider believes that these current conditions will develop into a care relationship with longevity over time, you can bill the code. For internal medicine, it's almost across the board.

 

[RTabacco]

I work at a clinic that focuses on our vulnerable population. We do a lot of SUD work. We are practically Medicaid focused. Our PTs often fear going to the ER or other clinics due to stigma they have felt for behavioral health issues, drug use, homelessness.

From my understanding G2211 represents the work the provider and staff put in to be a trusted agency for the PT. Which is something we are definitely doing. G2211 just isn't accepted by Washington Medicaid so we just can't access it.