It’s not often that CMS presents coders with a way to collect more for E/M visits, but in 2024, you’re about to benefit from a relatively new add-on code that allows you to do just that with the implementation of G2211 effective January 1.
Discover the facts you must know if you want to collect for HCPCS code G2211 next year.
Medicare Plans to Pay It With E/M Codes
Although CMS plans to start paying for 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]) in January, the code has actually been around since 2021. However, no RVUs were assigned to it until now, when you’ll be able to collect approximately $16 for it when reported with an E/M code.
As an add-on code, you cannot report G2211 on its own. Instead, you’ll report it along with your applicable office visit, hospital visit and other E/M codes to reflect the provider’s ongoing care (also referred to as longitudinal care).
For instance, suppose a patient with diabetes presents to her general practitioner to evaluate whether she might be a candidate for an injectable weight loss medication. The provider has been following the patient for all of her health care issues for nine years. After performing a level-four established patient E/M visit, the provider reports 99214 along with G2211.
G2211 Is Not Restricted to Primary Care
Although the descriptor for G2211 emphasizes that the provider is serving as the “continuing focal point for all needed health care services,” it’s not restricted to primary care providers (PCPs). Any provider who serves as the patient’s source of ongoing care can add G2211 to the E/M service, although most submissions are expected to come from general practitioners.
An example of a non-PCP reporting G2211 might involve a patient in a rural area who has to drive an hour to see her oncologist, who she’s been seeing for six years, and she doesn’t see any other physicians outside of those visits. Because the oncologist is the only provider following the patient’s care over time, that provider is her continuing focal point and can justify adding G2211 to E/M claims.
Providers Expected to Bill G2211 With 38% of E/Ms
CMS expects to see G2211 reported on about 38% of all outpatient E/M visits at first, and they expect that number to rise eventually. In addition, you can report G2211 with telehealth E/Ms as well, so remember to use this add-on code with your telehealth visits when warranted to bring in that extra pay.
Avoid G2211 With Modifier 25
If you’re coding an evaluation management service and you are using a modifier 25 on that service, that means you’re billing your E/M service along with a procedure. And in those cases, Medicare will not pay for G2211. Instead, your MAC will reimburse you for the 25-modified E/M code and the procedure, but will not provide reimbursement for G2211.
There’s much more to know about G2211, as well as the other information that CMS shared in the 2024 Fee Schedule. Expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC shares all the details during her exclusive online training, Ace 2024 CMS Fee Schedule Updates: G2211, Telehealth & More. Sign up today!
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