Podiatry Coding & Billing Alert

You will no longer be able to report G2058 in 2021.

The Centers for Medicare & Medicaid Services (CMS) has released the January 2021 quarterly updates to the HCPCS Level II file. You’ll see several additions, including two new HCPCS codes to use when you bill Medicare for prolonged or complex evaluation and management (E/M) visits this year.

Editor’s note: The effective date for these codes was January 1, 2021, unless otherwise specified.

Read on to learn how to report these new HCPCS Level II codes in your podiatry practice.

Discover New Code G2212

You gained new HCPCS Level II code G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416) (do not report g2212 for any time unit less than 15 minutes)) in 2021.

Medicare wants coders to use G2212 to represent prolonged services, instead of new CPT^® add-on code +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services), but only with the following level 5 office/outpatient E/M services:

• 99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.)
• 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.)

Mark Down These New Patient and Clinician-Documented Codes

In 2021, you will also see several new clinician-documented codes:

• G2178 (Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer’s, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation)
• G2179 (Clinician documented that patient had medical reason for not performing lower extremity neurological exam)

In addition, you will receive a couple of new codes that directly describe the patient or how the patient acted during the patient encounter:

• G2184 (Patient does not have a caregiver)
• G2209 (Patient refused to participate)

Notice 1 Revised Code

You’ll also see one podiatry-related revision in 2021. (Emphasis added): G8658 (Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs intake survey lepf prom at initial evaluation on admission and/or follow up fs status survey near discharge, reason not given).

Don’t miss: As you can see, the fs intake survey on admission has now changed to a passive range of motion (PROM) at initial evaluation.

Say Goodbye to These Deleted Codes in 2021

HCPCS will also delete several codes in 2021. For example, you will no longer be able to report code G2058 (Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491))

You will also see some code deletions related to medications. In 2021, you will no longer be able to report codes G9365 (One high-risk medication ordered) and G9366 (One high-risk medication not ordered).