Sometimes it may feel like you’re navigating the G2211 coding and payment rules without much guidance, since CMS updates about how to report this E/M add-on have been sparse. Fortunately, one Part B MAC has come out with nearly a dozen FAQs that untangle several issues that coders have encountered since this code became payable on Jan. 1.
Last week, Medicare administrative contractor National Government Services (NGS) issued a fact sheet about G2211 — check out some of the surprising directives.
Here’s How to Report G2211 With 99211
NGS has clarified that G2211 is billable with 99211, and even presented a scenario when this may be applicable. “For example, a blood pressure check by an office nurse, in the context of a course of care for uncontrolled hypertension, may warrant G2211,” NGS said.
Keep in mind, of course, that this service — like all G2211 visits — must be part of a longitudinal period of care for a complex or chronic condition.
And by “longitudinal,” this means the provider is continuing a relationship with the patient “that is expected to be of significant duration,” NGS notes. You can’t add G2211 to your E/M codes if you’re simply addressing a self-limiting condition during an isolated service.
Frequency, Duration Limits Aren’t Applicable
Many practices have questioned how long they must spend with the patient to qualify for G2211, and whether there’s a limit to how often they can use the add-on code, but NGS has clarified both those issues.
“There are no frequency or duration limitations on G2211,” the payer said. “Medical necessity is the primary factor in considering the use of this code; the medical record must support the key elements of the code’s definition and requirements.”
Therefore, as long as your documentation demonstrates medical necessity and the other code requirements, you shouldn’t have to worry about frequency or duration.
Use G2211 for Outpatients
When asked which place of service (POS) applies to G2211, NGS replied that the add-on code can reported in the office (POS 11) as well as in outpatient settings (POS 19 and 22 — outpatient hospitals).
You can also collect for G2211 with telehealth services, and for incident-to visits, NGS noted.
Get Guidance From Your MAC
Keep in mind that NGS is one Part B MAC, and your payer may have different payment criteria for this add-on service. Always check with your own insurer to get specific guidance on what’s payable.
Collecting for G2211 means knowing the ropes, and they are complicated. Expert Dreama Sloan-Kelly, MD, CCS, CPC, can help you untangle the regulations. During her online training, G2211: Collect $16 More Per E/M Visit in 2024 With Key Tips, she’ll provide you with actionable tips that can help you code and bill properly to collect maximum income this year. Register today!
Watch this quick expert video describing how to use G2211 for new and established patients, and subscribe to our YouTube channel for more expert advice!
 | Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. | |
| |