G2211?

[GlowInTheDark]

Anyone using/going to use this underwhelming but overly touted code to make another $16?

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[cowboydoc]

Sounds more problematic than bumping to a 99215, with less upside.

 

[callmeanesthesia]

16 extra dollars on every Medicare medial branch block follow-up? That’ll add up.

 

[epidural man]

Isn't it supposed to be used for a telehealth visit?

 

[sdnuser001]

Can someone explain what this code is?

 

[callmeanesthesia]

Can someone explain what this code is?

Add on code for visit complexity. Mainly intended to boost up primary care but I’m pretty sure most of our patients will qualify.

https://www.cms.gov/files/document/physician-fee-schedule-pfs-payment-officeoutpatient-evaluation-and-management-em-visits-fact-sheet.pdf

 

[SSdoc33]

Anybody know the RVU equivalent?

 

[SSdoc33]

It is .33.

I’m not sure why we wouldn’t use this code. It is actually a significant difference

 

[sdnuser001]

This can be used for clinic visits and procedures?

 

[callmeanesthesia]

This can be used for clinic visits and procedures?

No. it’s an add-on code that can be billed with E&M visits. Also says it shouldn’t be billed with codes with a 25 modifier.

 

[bedrock]

Hm. I’m definitely interested in this.

I bill a level 4 for most visits unless the patient is doing well.

We all have those patients that suck out our soul and put us behind.

I wonder if a level 4 + this code would be more or less risky to bill than a level 5?

 

[epidural man]

Hm. I’m definitely interested in this.

I bill a level 4 for most visits unless the patient is doing well.

We all have those patients that suck out our soul and put us behind.

I wonder if a level 4 + this code would be more or less risky to bill than a level 5?

I code a level 4 for initial.

But ever since I started using Marinol, all my follow ups are super easy. (I know, I know..you all hate Marinol for pain).

Me: How's it going since we started the Marinol
Them: Great! It is really helpful

Me: any side effects?
Them: Nope

Me: Are you getting drowsy or feel "stoned"
Them: Nope. Not at all. It does help me sleep however. I haven't slept this good in a long time. Thanks doc

Me: Do you need more?
Them: Nope

Do you need less?
Them: nope

Me: Alright - see you in 3 months.

 

[sdnuser001]

Hm. I’m definitely interested in this.

I bill a level 4 for most visits unless the patient is doing well.

We all have those patients that suck out our soul and put us behind.

I wonder if a level 4 + this code would be more or less risky to bill than a level 5?

Based on what I read all our patients essentially qualify for this code?

 

[RoloTomassi]

CMS Implemented G2211 in 2024

CMS implemented add-on code G2211 in 2024. This code is for practitioners who use E/M services to report most of their services. CMS believes

codingintel.com

"CMS expects that G2211 will be billed with 38% of all E/M services initially and 54% of all E/M services when fully adopted."

Pretty much all patients with chronic issues who you see routinely should qualify. This will be a big hit to the Medicare budget if utilized to this extent. Wonder where they're going to make compensatory cuts.

 

[bedrock]

I code a level 4 for initial.

But ever since I started using Marinol, all my follow ups are super easy. (I know, I know..you all hate Marinol for pain).

Me: How's it going since we started the Marinol
Them: Great! It is really helpful

Me: any side effects?
Them: Nope

Me: Are you getting drowsy or feel "stoned"
Them: Nope. Not at all. It does help me sleep however. I haven't slept this good in a long time. Thanks doc

Me: Do you need more?
Them: Nope

Do you need less?
Them: nope

Me: Alright - see you in 3 months.

LOL

How effective is Marinol for pain ? What kind of pain?

Do you bill for level 3, 4 etc in the military? I thought it was straight salary?

 

[epidural man]

LOL

How effective is Marinol for pain ? What kind of pain?

Do you bill for level 3, 4 etc in the military? I thought it was straight salary?

Yes I have to code. It’s dumb since it really means nothing. Someone somewhere supposedly uses the data for productivity.

I used it for arthritic pain mostly.

 

[drrosenrosen]

"Example 2: In the context of specialty care, HCPCS code G2211 could recognize the resources inherent in engaging the patient in a continuous and active collaborative plan of care related to an identified health condition the management of which requires the direction of a clinician with specialized clinical knowledge, skill and experience. Such collaborative care includes patient education, expectations and responsibilities, shared decision-making around therapeutic goals, and shared commitments to achieve those goals."

Could probably template some of this language to add some garbage to your note for billing purposes, if you were so inclined.

 

[clubdeac]

Why would you use this instead of just increasing from a level 3 to a level 4 or 4 to 5?

 

[RoloTomassi]

Why would you use this instead of just increasing from a level 3 to a level 4 or 4 to 5?

It's an add-on code, billed in addition to the usual 3/4

 

[CleanUp]

I’m a little confused.

Like someone suggested if we throw in some key words about natural supplements, expectations, shared decision making, and shared responsibilities then it qualifies?

 

[kstarm]

"Example 2: In the context of specialty care, HCPCS code G2211 could recognize the resources inherent in engaging the patient in a continuous and active collaborative plan of care related to an identified health condition the management of which requires the direction of a clinician with specialized clinical knowledge, skill and experience. Such collaborative care includes patient education, expectations and responsibilities, shared decision-making around therapeutic goals, and shared commitments to achieve those goals."

Could probably template some of this language to add some garbage to your note for billing purposes, if you were so inclined.

This sounds like chronic opioid management would fit this to me...

 

[clubdeac]

It's an add-on code, billed in addition to the usual 3/4

Yes so instead of billing a level 3 with this add on code just bill a level 4. Does that make sense

 

[RoloTomassi]

Yes so instead of billing a level 3 with this add on code just bill a level 4. Does that make sense

A 3's a 3, 4's a 4. Add this to whichever

 

[clubdeac]

A 3's a 3, 4's a 4. Add this to whichever

Didn’t answer my question

 

[callmeanesthesia]

Didn’t answer my question

If your billing note meets level 3 complexity, you bill 99213 plus G2211. If it meets level 4 requirements, you bill 99214 plus G2211. It’s a bonus payment for the added work of a longitudinal relationship.

 

[clubdeac]

If your billing note meets level 3 complexity, you bill 99213 plus G2211. If it meets level 4 requirements, you bill 99214 plus G2211. It’s a bonus payment for the added work of a longitudinal relationship.

Don’t get it. So if you see the patient back for fu (longitudinal) you can bill this? Seems stupid but hey if they want to pay more that’s cool

 

[callmeanesthesia]

Don’t get it. So if you see the patient back for fu (longitudinal) you can bill this? Seems stupid but hey if they want to pay more that’s cool

That’s exactly it. I think you can bill it on new patient visits too. Anything that’s a single serious condition or complex chronic condition. So, most of our Medicare patients. Get paid $16 more or whatever it is for the same visit you were doing. Don’t worry, I’m sure they’ll make up for it by cutting procedural reimbursement.

 

[SgtThunderfistMD]

Can you use this code on non-Medicare patients as well? I read not every carrier is forced to pay for it, but I'm HOPD RVU-compensated so I get paid for what I bill, not what we get paid for.

Seems to make a ton of sense for chronic med management, not sure if anyone is using it on folks that come in for injections? Only because who know when/if they will ever come back for a return visit for another intervention.

 

[IAmTheOne1]

Can you use this code on non-Medicare patients as well?

I have started billing it for HMO's, Medicaid, and Tricare. I was told by my billing company NOT to use it for PPOs. No claims have been processed yet so we'll see how it goes.

 

[Doctodd]

I’m a little confused.

Like someone suggested if we throw in some key words about natural supplements, expectations, shared decision making, and shared responsibilities then it qualifies?

it's our genius govt at work

 

[CleanUp]

If your billing note meets level 3 complexity, you bill 99213 plus G2211. If it meets level 4 requirements, you bill 99214 plus G2211. It’s a bonus payment for the added work of a longitudinal relationship.

Any idea what they define as a longitudinal relationship?

 

[BobBarker]

I have been using for med mgmt patients only.

 

[Sig123]

Thanks for the reminder to start using this code. As of now, there are no specific documentation requirements that I can find. Sounds like they will come out at some point in the future.

Agree w/ use of long-term opiate patients which creates the "longitudinal relationship"

 

[drrosenrosen]

I've started doing this for all my med management followups. I'm doing for all payors and will see what happens regarding whether this code is getting paid or not. We made this dot phrase to add language from the CMS documentation:

This patient is being managed for a complex and serious condition that requires ongoing, intensive medical management. The nature of this condition demands constant vigilance and a nuanced approach to treatment. The seriousness of the condition necessitates an in-depth and focused approach to management, including regular monitoring and potential coordination with other healthcare professionals.

Detailed Description of Visit Complexity: This visit involved an intricate evaluation and management of the patient's condition. The complexity of the visit was due to the need for a detailed assessment of the current state, consideration of potential complications, and a careful balancing of treatment options to manage the condition effectively.

Patient's Health Status and History: This patient has a significant pain history which requires regular and detailed management. The condition's impact on their life and health is substantial, necessitating a comprehensive and tailored approach to care.

 

[Sig123]

I've started doing this for all my med management followups. I'm doing for all payors and will see what happens regarding whether this code is getting paid or not. We made this dot phrase to add language from the CMS documentation:

This patient is being managed for a complex and serious condition that requires ongoing, intensive medical management. The nature of this condition demands constant vigilance and a nuanced approach to treatment. The seriousness of the condition necessitates an in-depth and focused approach to management, including regular monitoring and potential coordination with other healthcare professionals.

Detailed Description of Visit Complexity: This visit involved an intricate evaluation and management of the patient's condition. The complexity of the visit was due to the need for a detailed assessment of the current state, consideration of potential complications, and a careful balancing of treatment options to manage the condition effectively.

Patient's Health Status and History: This patient has a significant pain history which requires regular and detailed management. The condition's impact on their life and health is substantial, necessitating a comprehensive and tailored approach to care.

Thanks so much for sharing this. Love it!

 

[PAINISGOOD]

I've started doing this for all my med management followups. I'm doing for all payors and will see what happens regarding whether this code is getting paid or not. We made this dot phrase to add language from the CMS documentation:

This patient is being managed for a complex and serious condition that requires ongoing, intensive medical management. The nature of this condition demands constant vigilance and a nuanced approach to treatment. The seriousness of the condition necessitates an in-depth and focused approach to management, including regular monitoring and potential coordination with other healthcare professionals.

Detailed Description of Visit Complexity: This visit involved an intricate evaluation and management of the patient's condition. The complexity of the visit was due to the need for a detailed assessment of the current state, consideration of potential complications, and a careful balancing of treatment options to manage the condition effectively.

Patient's Health Status and History: This patient has a significant pain history which requires regular and detailed management. The condition's impact on their life and health is substantial, necessitating a comprehensive and tailored approach to care.

Do you put all 3 paragraphs in each visit?? Very nice and detailed.

 

[thiswonthurtabit]

Do you put all 3 paragraphs in each visit?? Very nice and detailed.

I stole it, made a dot phrase and have put the whole thing in 4 visits from today that I felt were appropriate.

 

[gaschicago]

I've started doing this for all my med management followups. I'm doing for all payors and will see what happens regarding whether this code is getting paid or not. We made this dot phrase to add language from the CMS documentation:

This patient is being managed for a complex and serious condition that requires ongoing, intensive medical management. The nature of this condition demands constant vigilance and a nuanced approach to treatment. The seriousness of the condition necessitates an in-depth and focused approach to management, including regular monitoring and potential coordination with other healthcare professionals.

Detailed Description of Visit Complexity: This visit involved an intricate evaluation and management of the patient's condition. The complexity of the visit was due to the need for a detailed assessment of the current state, consideration of potential complications, and a careful balancing of treatment options to manage the condition effectively.

Patient's Health Status and History: This patient has a significant pain history which requires regular and detailed management. The condition's impact on their life and health is substantial, necessitating a comprehensive and tailored approach to care.

Where in the note do you add this verbiage. Is it under a specific ICD10?

 

[Ducttape]

nice dot phrase.

i am again struck, however, by how meaningless is the mumbo jumbo we are required to document.

 

[PAINISGOOD]

I've started doing this for all my med management followups. I'm doing for all payors and will see what happens regarding whether this code is getting paid or not. We made this dot phrase to add language from the CMS documentation:

This patient is being managed for a complex and serious condition that requires ongoing, intensive medical management. The nature of this condition demands constant vigilance and a nuanced approach to treatment. The seriousness of the condition necessitates an in-depth and focused approach to management, including regular monitoring and potential coordination with other healthcare professionals.

Detailed Description of Visit Complexity: This visit involved an intricate evaluation and management of the patient's condition. The complexity of the visit was due to the need for a detailed assessment of the current state, consideration of potential complications, and a careful balancing of treatment options to manage the condition effectively.

Patient's Health Status and History: This patient has a significant pain history which requires regular and detailed management. The condition's impact on their life and health is substantial, necessitating a comprehensive and tailored approach to care.

This can work for G3002 as well

 

[IAmTheOne1]

This can work for G3002 as well

Are you billing for G3002? My interpretation was this is really basically only useful for PCPs as they manage pain separately from E/M code. Can't count same work twice (once for G3002 and once for E/M).

 

[PAINISGOOD]

Are you billing for G3002? My interpretation was this is really basically only useful for PCPs as they manage pain separately from E/M code. Can't count same work twice (once for G3002 and once for E/M).

Its not limited to primary care. If you read the description of code ANY provider that provides chronic pain management can bill this.

 

[IAmTheOne1]

Its not limited to primary care. If you read the description of code ANY provider that provides chronic pain management can bill this.

I don't think you understood my message. I didn't say it can only be used by primary care. I said it's really only useful for primary because billing the code by itself for pain management pays less than the E/M. And you can't bill the G code and E/M code both together for pain management because you are counting the work twice.

 

[Ducttape]

how much extra is one getting reimbursed for using this code - since apparently you cant use in addition to the baseline E/M code?

 

[thiswonthurtabit]

how much extra is one getting reimbursed for using this code - since apparently you cant use in addition to the baseline E/M code?

Add on code. Theoretically 16-18 bucks depending on locality per the CMS calculator (Overview of the Medicare Physician Fee Schedule Search | CMS)

G2211 Add-on Code: What It Is and How to Use It

The care you provide your patients is complex and comprehensive. G2211 will help you get paid more accurately for it.

www.aafp.org

 

[PAINISGOOD]

I don't think you understood my message. I didn't say it can only be used by primary care. I said it's really only useful for primary because billing the code by itself for pain management pays less than the E/M. And you can't bill the G code and E/M code both together for pain management because you are counting the work twice.

Wrong! I am getting paid for both. E/M based on medical decision making.

 

[IAmTheOne1]

Wrong! I am getting paid for both. E/M based on medical decision making.

You are getting paid for both, but if you are audited I don't think you will pass. "a patient can receive an E/M service on the same day as the chronic pain management service, but there must be no overlay between the two services." You are double-dipping.

 

[PAINISGOOD]

You are getting paid for both, but if you are audited I don't think you will pass. "a patient can receive an E/M service on the same day as the chronic pain management service, but there must be no overlay between the two services." You are double-dipping.

• G3002: Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.)

Discussing goals of chronic pain, coordination of care with PT, etc for this can be separated from E/M visits such as discussing procedures, meds etc.

 

[IAmTheOne1]

I don’t know, the phrase “overall treatment management” sounds pretty all encompassing for anything pain related.

The intention is if a pcp is managing your HTN, DM, CAD and then after doing all that, start discussing pain. Clearly distinctly different services.

Trust me, I would love nothing more than to get an extra $70-80 on top of the pathetic e/m payment, but I don’t know if this is medicares intention = potential failed audit.

 

[PAINISGOOD]

I don’t know, the phrase “overall treatment management” sounds pretty all encompassing for anything pain related.

The intention is if a pcp is managing your HTN, DM, CAD and then after doing all that, start discussing pain. Clearly distinctly different services.

Trust me, I would love nothing more than to get an extra $70-80 on top of the pathetic e/m payment, but I don’t know if this is medicares intention = potential failed audit.

I'm getting it independently audited. Will update when I have more info