G2211?

[BobBarker]

Re: G3002
I can never imagine spending 30min for a follow up visit.

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[Doctodd]

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

update? G3002 seems more appropriate on it's face.

 

[IAmTheOne1]

I spoke with Noridian who manages our Medicare claims. They stated that G3002 CAN be billed with E/M, which we knew. The rep couldn't clarify the conditions that would make them eligible to bill together. I did submit a test claim with both E/M and G3002, both of which paid (on an encounter where I did have to spend more than 30 minutes). But I'm not going to submit both regularly (since I don't regularly spend 30 minutes anyways, but also because I still think it's double-dipping and would not pass an audit when used by pain management specialists).

On the other hand, I've been submitting G2211 regularly with E/M. They've been paying consistently for both and I think we are well within reason to bill G2211 on almost every E/M encounter based on both mine and my billers interpretation of the coding criteria.

 

[RoloTomassi]

I spoke with Noridian who manages our Medicare claims. They stated that G3002 CAN be billed with E/M, which we knew. The rep couldn't clarify the conditions that would make them eligible to bill together. I did submit a test claim with both E/M and G3002, both of which paid (on an encounter where I did have to spend more than 30 minutes). But I'm not going to submit both regularly (since I don't regularly spend 30 minutes anyways, but also because I still think it's double-dipping and would not pass an audit when used by pain management specialists).

On the other hand, I've been submitting G2211 regularly with E/M. They've been paying consistently for both and I think we are well within reason to bill G2211 on almost every E/M encounter based on both mine and my billers interpretation of the coding criteria.

Do you know if any commercial insurances are paying G2211?

 

[IAmTheOne1]

Do you know if any commercial insurances are paying G2211?

No, they are not. Neither is Medicaid, HMO's, or Tricare. I have a feeling they will start to, but it may be a while.

 

[PAINISGOOD]

update? G3002 seems more appropriate on it's face.

Independent coder/auditor said can be billed but you, the doctor, has to spend 30 min with patient and MA time does not count.

 

[CleanUp]

since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi

 

[GatorCHOMPions]

since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi

Isn't that just part of MDM? What is the separate code you use?

 

[Asclepius186]

since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi

I’m assuming this is for in office X-rays without a radiologist read? I thought otherwise an independent interpretation of an xray read by a radiologist was just a part of E and M

 

[CleanUp]

I’m assuming this is for in office X-rays without a radiologist read? I thought otherwise an independent interpretation of an xray read by a radiologist was just a part of E and M

You are correct I am reading the film not a radiologist. I am clear the date it was taken, the date it was interpreted, and my impression.

Isn't that just part of MDM? What is the separate code you use?

I was told it is separate because I am interpreting the film without a radiologist. For example lumbar 4 views 72110

Others found here https://rbarad.com/wp-content/uploads/2021/03/19-RBA-0011-RBA-X-Ray-CPT-Codes_2021.pdf

 

[BobBarker]

I think that is appropriate to read your own films and bill for it like ortho does as long as you have a diagnostic X-ray in your office and a PACs to store the films.

 

[CleanUp]

I think that is appropriate to read your own films and bill for it like ortho does as long as you have a diagnostic X-ray in your office and a PACs to store the films.

Correct that’s what I do just like ortho.

I figure I am taking the med legal risk so might as well get some reimbursement.

 

[MitchLevi]

I think that is appropriate to read your own films and bill for it like ortho does as long as you have a diagnostic X-ray in your office and a PACs to store the films.

This is what I do.

Spine and joints. I read my own XRAYs and bill for them.

 

[SSdoc33]

This is reasonable, but just don’t miss a tumor. Or ankylosing spondylitis. Or a bunch of other stuff.

You are taking on a fair amount of risk if you read you own X-rays. There’s more to miss along the spine than in knees and shoulders

 

[CleanUp]

This is reasonable, but just don’t miss a tumor. Or ankylosing spondylitis. Or a bunch of other stuff.

You are taking on a fair amount of risk if you read you own X-rays. There’s more to miss along the spine than in knees and shoulders

I agree with your point about more to miss in the spine than the knees and shoulders. However, practically speaking, for those who work in a ortho group it is standard culture to get X-rays in office. Most people will end up getting MRIs.

I have a few times been concerned about the scary things and I will get additional imaging which is of course read by a radiologist.

 

[Agast]

I took @drrosenrosen blurb and turned it into this:

"This patient is being managed for a complex chronic pain that requires ongoing medical management. The nature of this condition requires a longitudinal relationship and monitoring over time for appropriate treatment." My biller says we haven't received any denials yet (started 2nd week of January) but she is still waiting on the EOBs.