Embracing G2211 and New Billing Strategies for 2024

Imagine a doctor's visit where the physician spends a lot of time with you, really digging into your health needs. That's what HCPCS add-on code G2211 and New 2024 Billing Opportunities are all about. It reflects the time, effort, and resources doctors put into visits where they build long-term relationships with patients and cover most of their healthcare needs over time.

The Centers for Medicare & Medicaid Services (CMS) came up with code G2211 to make sure doctors get adequately reimbursed for these types of visits. It helps account for the extra costs involved in caring for patients over the long haul, especially in primary care and other types of ongoing care.

When considering when to use G2211, it's important to note that this HCPCS code becomes effective for payment from January 1, 2024, onwards. G2211 serves as an additional code applicable to both new and established patient office or outpatient evaluation and management (E/M) services. This code is utilized when the healthcare provider serves as the primary coordinator for all the patient's medical needs. As per CMS guidelines, the nature of the relationship between the patient and the physician dictates when this code should be billed. It's essential to emphasise that G2211 is specifically designed for office and outpatient E/M services falling under CPT codes 99202-99215.

Conversely, G2211 should not be used under circumstances where the doctor-patient relationship is brief, routine, or confined to a particular period. For instance, if a physician attends to a patient's acute issue without committing to ongoing medical care or without consistently planning to manage the patient's health over time, HCPCS G2211 should not be reported.

To initiate billing for G2211, the first step is to ensure your Electronic Health Record (EHR) and billing systems are updated to align with the 2024 Medicare physician fee schedule. Confirm that G2211 has been included in these updates; typically, your practice management or billing and coding personnel can assist with this task. It's important to advise patients about potential additional charges on their bills due to deductible and coinsurance factors.

When reporting HCPCS code G2211, it should be paired with office visits where you have taken on or plan to undertake responsibility for the patient's ongoing medical care. Notably, G2211 can only be billed with office visits that already include modifier 25.

Educating your administrative and coding staff about the significance of G2211 and New 2024 Billing Opportunities is crucial. They should understand that primary care office visits involve intricate care delivery compared to other medical specialties. Primary care physicians juggle a multitude of complex tasks during brief visits, including managing acute and chronic conditions, providing preventive services, counseling patients, and addressing behavioral health and social needs. G2211 is necessary to accurately reflect the added complexity and associated costs of this comprehensive care.

Before diving into billing for this service, it's essential to consider a few key points:

• Providers who bill for the add-on code are expected to offer ongoing care to the patient over time.
• However, if providers don't plan to establish a continuing relationship with the patient (such as urgent care, consultants, or second opinions), they should refrain from billing G2211.
• Both primary care physicians and specialists are eligible to bill this add-on code.
• When billing, make sure to pair G2211 with an office visit or another outpatient evaluation and management (E/M) service.
• Good news! G2211 can also be billed alongside telehealth services.
• Avoid billing G2211 if the E/M service already includes modifier 25 for a procedure performed by the same provider.
• Similarly, refrain from billing G2211 if chronic or complex conditions are noted but not fully addressed during the patient's E/M visit.

While there aren't specific documentation guidelines from CMS for G2211, a stakeholder call in November 2023 hinted at forthcoming details, including documentation examples, in a future Medicare Learning Network article. It's a best practice to develop an internal policy regarding the use of this code, taking these factors into account.

It's worth noting that Medicare officials acknowledge the inadequacy of current office visit E/M payments in fully compensating primary care physicians for the intricate care they provide. Existing coding methods excel in documenting procedures but need to improve in depicting cognitive services like continuous, comprehensive primary care.

Moreover, current E/M coding needs to capture many of the unique services and resources offered by primary care physicians or recognize their exceptional role in care coordination. The typical primary care physician catering to Medicare patients must coordinate care with an extensive network of 229 other physicians across 117 practices. This demonstrates the vital importance of G2211 in accurately reflecting the value of primary care services.

Acknowledging a long-standing issue, CMS recognizes the historical under-reimbursement of providers for their intellectual skills and cognitive efforts. In a significant move, CMS anticipates that 38 percent of all E/M services in 2024 will involve billing with G2211 and New 2024 Billing Opportunities. This add-on code carries a national payment rate of $16.04, with a corresponding work relative value unit (wRVU) of 0.33. Given the reduction in the conversion factor for 2024, G2211 could serve as a means to counterbalance some of the revenue decline.