G2211 is a new billing code all ambulatory providers are highly encouraged to begin using, when appropriate.
Regardless of your subspecialty, do you provide continuity of care for patients? If yes, there is a new billing code to capture some of the work you are already doing—and does not require more documentation! This new CPT code, G2211, (1) is not specialty specific, (2) may apply to a majority of your clinic encounters, and (3) will provide you with additional WRVU and revenue for your time.
Considerations for Use of G2211:
- Are you the continuing focal point for all needed services, like a primary care practitioner? Or
- Are you providing ongoing care for a single, serious condition or a complex condition (e.g. sickle cell, HIV, chronic kidney disease, heart failure, diabetes, etc.)?
G2211 Key Takeaways:
- Helps account for additional resources associated with treating a patient’s single, serious condition, or complex condition, and serving as the continuing focal point for the patient’s health care service needs
- Only billed in addition to an office/outpatient E&M service (e.g., 99204, 99215, etc)
- Not billable when billing another service with modifier-25
For more information, (1) see case examples from CMS (Medicare) below, (2) refer to the attached tip sheet from our professional fee billing compliance office, and/or (3) consult the FAQ from the Department of Medicine. If you have additional questions regarding the use of this code, please feel free to contact Kasey Hutchinson ([email protected]), director of DOM Accounts Receivable.
Helpful G2211 Case Examples
CMS Example #1
A patient with HIV has an office visit with you, their infectious disease physician. The patient tells you they’ve missed several doses of HIV medication in the last month because you’re part of their ongoing care and have earned their trust over time. You tell them it’s important not to miss doses of HIV medication, while making the patient feel safe and comfortable sharing information like this with you in the future.
If you didn’t have this ongoing relationship with the patient and the patient didn’t share this with you, you may have decided to change their HIV medicine to another with greater side effects, even when there was no issue with the original medication. Because you’re part of ongoing care for a single, serious condition or a complex condition such as HIV, and have to weigh these types of factors, the office visit is more complex. In this example, you may bill G2211 in addition to your office visit code (e.g., 99214).
CMS Example #2
A patient sees you, their primary care practitioner, for sinus congestion. You may suggest conservative treatment or antibiotics for a sinus infection. You decide on the course of action and the best way to communicate the recommendations to the patient in the visit. How the recommendations are communicated is important in that it not only affects the patient’s health outcomes for this visit, but it also can help build an effective and trusting longitudinal relationship between you and the patient. This is key so you can continue to help them meet their primary health care needs.
The complexity that code G2211 captures isn’t in the clinical condition (the sinus congestion). The complexity is in the cognitive load of the continued responsibility of being the focal point for all needed services for this patient. There’s important cognitive effort of using the longitudinal doctor-patient relationship itself in the diagnosis and treatment plan. These factors, even for a simple condition like sinus congestion, make the entire interaction inherently complex. In this example, you may bill G2211 in addition to your office visit code (e.g., 99213).
Reference: CMS MLN Matters Visit Complexity Add-on Code
