Wiki GG211

[JVILLAS]

I'm having trouble really understanding this code. It states for chronic and ongoing care we can use this as long as its documented properly. Does the provider who uses this code be the only provider who sees this patient for this condition?

I ask because I am seeing other Pediatrician offices use this code on every sick visit. I cant imagine every one of their visits is a chronic and longitude care type of situation.

I would appreciate any input.

Thank you

Jennifer

 

[janny]

I'm having trouble really understanding this code. It states for chronic and ongoing care we can use this as long as its documented properly. Does the provider who uses this code be the only provider who sees this patient for this condition?

I ask because I am seeing other Pediatrician offices use this code on every sick visit. I cant imagine every one of their visits is a chronic and longitude care type of situation.

I would appreciate any input.

Thank you

Jennifer

Hi Jennifer,
This is a confusing one for sure. My own interpretation was limited to billing it where encounters include something that is related to or limited/affected by the type of condition described. Now I see that all important "and/or" in the descriptor:

"services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition."

American Academy of Pediatrics explores this code in the April 2024 issue of their Pediatric Coding Newsletter. In it, they caution against billing it for encounters that "...is not intended to establish or continue a longitudinal relationship." It alludes to CMS's descriptor of the code as representing "...the cognitive load of the continued responsibility of being the focal point for all this patient’s health care needs (ie, whole-person preventive and problem-oriented care)." This, many would agree, describes a lot of encounters in good, ongoing pediatric care. I would check with your clinicians for their view.

The article includes helpful scenarios that feature primary and specialty care vignettes where the codes is recommended by them. Well worth the price of subscription, IMO.

Good Luck!

 

[JVILLAS]

Yes I read that article, feels vague. I feel like they want to leave it to the providers view but then you have providers or offices who take it as "well lets just bill it". And so I'm having a hard time explaining since its not black and white with a little bit of ethics on it lol.

Thanks again