Coding Corner: A New Code to Compensate for Providing Complex, Longitudinal Care: G2211 | David Holtz, MD

David Holtz, MD

Beginning January 1, the Centers for Medicare & Medicaid (CMS) started providing payment for HCPCS G2211 – visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. The code may be used to capture the additional time and resources associated with providing ongoing medical care that is above and beyond the resources associated with typical office evaluation and management (E/M) services. Consequently, code G2211 is an add-on code that may be appended to claims with E/M services provided in the office or outpatient setting only. G2211 should not be billed with other E/M services such as inpatient E/M services. The added reimbursement from Medicare, approximately $16.00, is intended to promote the following goals:

• Pay for the added resources associated with building longitudinal relationships with Medicare patients.
• Address patients health care needs with consistency and continuity over long periods of time.
• Allow for the provision of E/M services to patients on an ongoing basis that results in care that is personalized to the patient.
• Improve delivery of team-based care that is accessible, coordinated, and integrated with the broader healthcare landscape.

The cancer care delivered by gynecologic oncologists is unquestionably long term, and we certainly become the continuing focal point for all needed health care services for the women we treat. CMS expects that 30-50% Medicare office visits will be billed with this add-on code, but the use of G2211 will vary by specialty.

CMS has provided information on the specific instructions as to how G2211 may be used, including the following:

• The code is an add-on code that may be billed only with office or outpatient E/M services.
• G2211 reported with E/M services provided on the same date of service.
• G2211 should not be reported on dates of service for which modifier- 25 would be appended to the E/M code (i.e., on the same date as a procedure code).
• It should not be reported if the service provided is for a condition that is temporary, transient, or self-limited.

To date, CMS has not provided any specific guidance as to the documentation needed to report the service. However, a recent transmittal issued by the agency does include additional information using specific clinical scenarios to describe how the agency expects the code to be used. The SGO Coding Subcommittee suggests including reasonable language in your note describing your plan for continued long term care of the patient. It is also important to document that you are the continuing focal point for healthcare services of the patients’ needs.

This code should lead to significantly improved reimbursement for the Medicare patients that you treat. The physicians, nurse practitioners, and PAa who care for women with cancer deserve recognition for the time and effort they put into establishing longitudinal and comprehensive care.

Stay tuned for more information on new CPT codes that SGO members may be able to use support other types of services that we provide to our patients, including assessing social determinants of health.

David Holtz, MD, is a gynecologic oncologist at Main Line Healthcare in Wynnewood, PA.

Join the SGO Coding and Reimbursement Subcommittee for the Annual Coding Course on Friday, March 15, from 1:00-4:00pm during the SGO Annual Meeting on Women’s Cancer in San Diego, CA. Delve into the process of creating CPT® codes, spanning surgical and E/M services. Navigate coding for diverse cases in ovarian, cervical, vaginal, and endometrial cancer, including pre-op consults, surgery, advanced care planning, and chemotherapy, enhancing your coding proficiency in a range of patient care scenarios. In these case based lectures, we will go through scenarios both common and complex, walking you through the billing of visits and surgery cases from start to finish. Presenters will also discuss new codes recently approved by the AMA RVS Update Committee (RUC) and how they can be utilized. Participants will be eligible for 3 CEUs upon completion.