Ever since the beginning of 2024, practices have been able to report G2211 to collect extra cash for longitudinal care performed with E/M visits. Since not every patient qualifies for this service and not every insurer will pay it, you must heed some guidelines before you bill this add-on code.
Check out five compliance considerations you must know before you can report G2211.
1. Don’t Report G2211 for Every Patient
To report G2211, your provider must be the continuing focal point for all needed services that the patient is receiving. Although this applies to many primary care providers, the code is not limited to primary care. Specialists who are serving as the ongoing focal point for the patient’s services may also bill it.
For instance, a cancer patient would be monitored regularly by their oncologist, who is serving as the main, continuing focal point for that patient’s care and their ongoing services for a complex condition. In that case, the provider should be able to append G2211 to their E/M code. However, it’s not appropriate for every visit with every patient just because patients have a complex condition. The documentation must show a continuing pattern of care by that provider.
2. Avoid G2211 With Straightforward Complaints
If you see a patient for a very straightforward issue, such as a quick referral to a specialist or an allergy visit that’s episodic in nature, that may not support G2211. Payers have said that G2211 visits don’t apply if the provider is simply addressing a self-limiting condition during an isolated service.
3. Don’t Overuse G2211 to Offset Pay Cuts
When Medicare lowers payment amounts or you start to see higher denial rates from other insurers, you may be looking for new avenues to offset those pay cuts, but G2211 is not the way to do that. Instead, only report it when your documentation supports your ongoing care with the patient and your continuing relationship.
4. Edit Any Notes Copied Forward
If you’re using an electronic health record for visits that involve reporting G2211, it’s often tempting to copy forward any documentation from previous visits into the next encounter. However, those notes must be edited for the current presentation or else auditors might see them as “cloned notes,” which don’t represent which services you provided on a specific date of service. Each note must be unique and reflect that day’s chief complaint, along with the other elements of provider documentation.
5. Don’t Double Dip With Care Management Claims
If you’re performing chronic care management or transitional care management during the same encounter when you’re billing G2211, make sure you aren’t double dipping. Although Medicare doesn’t restrict you from reporting both on any particular date of service, you must have separate documentation supporting those different services. Overlapping documentation will only support one of those services, not both.
If you find G2211 confusing, you’re not alone. Let coding expert Toni Elhoms, CCS, CPC, CPMA, CRC, CEMA, AHIMA-Approved ICD10-CM/PCS Trainer help during her latest online training event, Stop New G2211 Edits from Costing You Thousands in E/M Revenue. Register today!
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