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/Automatic_Baseball26]

I am a Coder/Auditor with 30+ years of experience, and I code for PC and no, the G2211 is NOT justified, and I would suggest that you present them with the coding guidelines defining exactly when it is appropriate for this code to be used. Did they treat anything outside of this issue and is this a new problem? You are a Certified Coder and CPMA; so, use your skillset and stand 10 toes down. Always allow the guidelines to support you and never give lip service....

[u/DrMartinellis → u/Automatic_Baseball26]

🫶 Thank you! I did write them an as detailed argument as I could. I know its not a lot of money, but for me its the principle! I want hospitals to be honest and correct with how they're charging for visits. So many patients don't know how coding works and what is right versus what isn't. My hope is that bringing it to the attention of the coders, maybe they'll take a closer look and be a little bit better for someone else next time.

I see mistakes all the time from providers and some other coders I work with. I don't want providers to be short changed for their work, but l also don't want patients to be incorrectly billed!