Wiki G2211

[KaylaRieken]

Anyone else having Aetna Medicare approve some G2211 and deny other claims with the same charges?

 

[Cheezum51]

One of my clients contacted me yesterday and said that Palmetto Medicare was denying payment for the G2211 but paying the E/M code fees. Strange since the code is listed when you use the CPT look up tool.
I'm guessing that the insurer claims systems are not properly set up to accept that code, as is typical with new things like this, which just makes more unnecessary work for the billing staff to deal with the denials.

Tom Cheezum, OD, CPC, COPC

 

[KaylaRieken]

Aetna has paid on the G2211 on some claims though and denied it on other claims.

 

[Cheezum51]

Do you think it may be diagnosis related? I haven't seen any list of diagnosis codes and CMS has not restricted the types of specialties that can use the code, to my knowledge. My client is not getting the G2211 paid for any claims right now. They're going to contact Palmetto to see what the issue is.

 

[davidinasheville]

we are regularly getting paid for G2211 by Palmetto Medicare. We have used many diagnoses (including acute problem codes and Z codes). It looks like it may work with all diagnoses.

Two issues that might affect payment: Using -25 modifier when billing; Problems with the clearinghouse (eg the Change Healthcare cyberattack).

 

[natashalage]

we were told not to use G2211 with procedures and phone e/m services.