Wiki Denial on G2211

[gayle89@gmail.com]

We are receiving denials on addon code G2211 when coded along with e/m services as bundled service for commercial insurance as well as for some Medicare insurance .We have tried by changing primary DX code (PAD and cardiac related conditions) but again received the same denial. Can anyone guide me on this denial

 

[csperoni]

G2211 is a Medicare code. Coverage for other carriers is at carrier discretion. However, it should be covered by Medicare. Are you billing it properly (ie appropriate E&M base code without -25)?

 

[gayle89@gmail.com]

G2211 is a Medicare code. Coverage for other carriers is at carrier discretion. However, it should be covered by Medicare. Are you billing it properly (ie appropriate E&M base code without -25)?

Thank you for response. Yes we are billing E&M code without 25 modifier.

 

[amyjph]

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html#member

https://www.cms.gov/files/document/mm13473-how-use-office-and-outpatient-evaluation-and-management-visit-complexity-add-code-g2211.pdf

https://med.noridianmedicare.com/web/jeb/specialties/em/complexity-add-on-code-g2211