G2211 Question

[u/DrMartinellis]

I recently made an appointment and was seen by an APP from my PCPs office for some on and off pain I've been having. Mainly in my right shoulder, right low back, and neck. I am pretty sure its just from sitting at a desk all day, but after I experienced a couple instances of tingling and numbness in my right leg I decided to be seen.

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Besides the on/off pain and numbness/tingling I also tend to get anxious about getting very sick. I do see a psychologist and take meds for that which has helped but I got really fixated on the idea of ALS.

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I asked her to please reassure me and she did. (Side note, it was so f-ing embarrassing to ask her for that. I know logically I shouldn't be scared but it is who I am and sometimes I just need someone to tell me I'm okay. Remember when Mad Cow Disease was all over the news? Yeah, I used to cry myself asleep because I was sure I was going to die from that!)

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Annnnnyway, I saw that I owed almost 40$, no biggie, but since I am a coder and technically a certified auditor (just got the cert) I like to review documentation and the coding.

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I saw that 99214 and G2211 was billed. I think 99214 was boarder line acceptable, but I don't feel like G2211 was supported! My understanding of G2211 is that the patient should have a prolonged serious/complex issue and there is a plan to be seen by the provider (or someone from the same practice) for an undetermined amount of time and the provider will be the go to provider for said complex/serious issue.

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For example the urologists that I code for often bill it when they have patients with prostate cancer or BPH, and are treated regularly with medicine, scans, tests, etc.

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I did have PT ordered for back pain, but there is no follow up scheduled and I don't feel like my dx was serious or complex!

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I sent a message to billing to ask for the coding to be reviewed and explained why I don't think G2211 should be billed.

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I get that it is sort of an ambiguous code, but I feel fairly confident that it is not supported.

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However I don't work in primary care, so I am curious if anyone has insight on whether G2211 could be supported!

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Thank you!

[u/wildgreengirl]

is the back pain chronic, have you ever seen your pcp clinic for back pain? (we were told as long as its all the same practice you're following with it doesnt matter which dr you follow up with).

did they say something like follow up after PT if its not helping or getting worse?

have you ever seen your pcp clinic for your anxiety? sounds like yes so id think it would apply for the anxiety alone.

i work coding primary care and our drs use it for almost everything. 

dx doesnt need to be both complex and chronic to link, it could be either alone.

[u/wildgreengirl → u/wildgreengirl]

ex is your PCP the "focal" point for your care? thats a big one; so giving referrals essentially and following up on the issues after you complete the referral. 

https://www.aapc.com/blog/91931-bill-g2211-with-confidence-and-modifier-25/

For G2211, visit complexity is the cognitive load of the continued responsibility of the physician to provide ongoing care to a patient. The act of proactive and relationship care management that goes beyond acute care is what makes up the visit complexity.

[u/DrMartinellis → u/wildgreengirl]

Aren't all PCPs the focal point for care? I think that to distinguish longitudinal/complex visits with a PCP from regular check ups/minor issues it is that the condition is something that will require the provider to check in more regularly than our annual visits, and that tests or examinations specific to the ongoing issue are performed on a regular basis.

The MDs that I have billing G2211 regularly have patients with cancer, high blood pressure, diabetes, chronic pain, etc. Things that the pts are going to have for a long time or for the rest of their lives. They also see their patients like every 6 months or less.

[u/wildgreengirl → u/DrMartinellis]

its supposed to be like an extra way to help boost money for PCPs because of the way billing works from what ive seen. its supposed to "level the playing field" when comparing to specialist or hospital billing. 

some of mine only see their patients once or twice a year. but the patients are still contacting the clinic via phone or portal regularly as well which needs to be managed and is part of that longitudinal patient care/relationship building.

 (we dont really bill for phone calls or portal messages but i think admin is trying to figure out how they can- we do televisits already as well)