SaVaughn
New
Wondering if anyone has crafted a company policy regarding documentation requirements for G2211 that they would be willing to share. My company struggles with determining when to apply G2211, particularly with Family Medicine.
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Wiki Internal Policies for G2211?
- Thread starter SaVaughn
- Start date
My company does not have a policy other than simply re-iterating the CMS and MAC guidance.
For primary care, it's really just about having the ongoing relationship with the patient and managing all issues. For any of your patients with chronic problems (HTN, DM, high cholesterol, etc) that you are managing, it would clearly be warranted. If you have younger, healthy patients who basically use their PCP as an urgent care every 2 years, then it's less appropriate.
For primary care, it's really just about having the ongoing relationship with the patient and managing all issues. For any of your patients with chronic problems (HTN, DM, high cholesterol, etc) that you are managing, it would clearly be warranted. If you have younger, healthy patients who basically use their PCP as an urgent care every 2 years, then it's less appropriate.
NRaizman
Guru
G2211 is for management of a -single, chronic condition- not for comprehensive management of all of a patient's conditions.
One's policy should only ask for documentation of a single, complex condition and that the provider is managing it and coordinating care.
There are, as you know, no CMS-mandated documentation requirements.
One's policy should only ask for documentation of a single, complex condition and that the provider is managing it and coordinating care.
There are, as you know, no CMS-mandated documentation requirements.
jkyles
True Blue
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The code applies to two basic categories: oversight of the patient's care and/or focus on a single serious or complex condition.
Here is the complete descriptor for the code.
Here is an FAQ that CMS released for the code last year.
The way I think of it, the documentation should support the provider's intent to meet one or both of the requirements in the descriptor. To give a negative example, if a PCP sees a new patient and refers them to a specialist with no mention of follow up, that clearly would not meet the requirements for G2211. Another not-G2211 example is the established patient who only comes in when they have specific problem (flu, sprained ankle, acute pain) and is not seen again until the next problem arises.
Here is the complete descriptor for the code.
Here is an FAQ that CMS released for the code last year.
The way I think of it, the documentation should support the provider's intent to meet one or both of the requirements in the descriptor. To give a negative example, if a PCP sees a new patient and refers them to a specialist with no mention of follow up, that clearly would not meet the requirements for G2211. Another not-G2211 example is the established patient who only comes in when they have specific problem (flu, sprained ankle, acute pain) and is not seen again until the next problem arises.
RTabacco
New
The February 2025 AAPC magazine has an article titled "Bill G2211 with confidence".
What I took away from that article about the codes 2 uses.
The first being a single serious complex condition. Such as HIV treatment or SUD treatment. Really sensitive stuff where the provider needs to earn a significant amount of trust from the patient. I think it is appropriate to add it to all of those visits.
The other is if your provider is the go-to person for the patients needs. I see this as the appointment going slightly out of scope. If the patient comes in for medication management and it is just cut and dry that, they were just seeing a doctor and it doesn't matter who. But then if the patient comes in for medication management and tells the provider they are food insecure and the provider tells the patient about locations where they can get free meals or where the food banks are. I would add G2211 to that as more came up because the patient trusts the provider.
So yeah, my understanding of it is an added layer of vulnerability in the appointment that the patient shows to the provider.
But then, my clinic just sees Medicaid patients and currently G2211 isn't on our medicaid fee schedule so its moot for me.
Everyone else, please correct me if I am wrong in what I was saying.
What I took away from that article about the codes 2 uses.
The first being a single serious complex condition. Such as HIV treatment or SUD treatment. Really sensitive stuff where the provider needs to earn a significant amount of trust from the patient. I think it is appropriate to add it to all of those visits.
The other is if your provider is the go-to person for the patients needs. I see this as the appointment going slightly out of scope. If the patient comes in for medication management and it is just cut and dry that, they were just seeing a doctor and it doesn't matter who. But then if the patient comes in for medication management and tells the provider they are food insecure and the provider tells the patient about locations where they can get free meals or where the food banks are. I would add G2211 to that as more came up because the patient trusts the provider.
So yeah, my understanding of it is an added layer of vulnerability in the appointment that the patient shows to the provider.
But then, my clinic just sees Medicaid patients and currently G2211 isn't on our medicaid fee schedule so its moot for me.
Everyone else, please correct me if I am wrong in what I was saying.
jkyles
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CMS does use the word trust in one of its examples in the final rule but that's just an example. For the serious/complex condition requirement you're looking at the patient's condition and the nature of the provider's care. So, it could be HIV or it could be COPD.
For the second example, you might be thinking of the SDOH assessment code, which is a separate service. Again, you're just looking at the patient/provider relationship. I would look for things like the provider is regularly speaking with other providers who also care for the patient, referring the patient to specialists, sending reminders to the patient between visits and so on. If they're also helping patients address an SDOH, that would be another hint, but it isn't necessary.
Finally, in its FAQ on the code CMS notes that it might not be appropriate for every single visit.
For the second example, you might be thinking of the SDOH assessment code, which is a separate service. Again, you're just looking at the patient/provider relationship. I would look for things like the provider is regularly speaking with other providers who also care for the patient, referring the patient to specialists, sending reminders to the patient between visits and so on. If they're also helping patients address an SDOH, that would be another hint, but it isn't necessary.
Finally, in its FAQ on the code CMS notes that it might not be appropriate for every single visit.
Sugarfoots2
New
Anyone in Michigan and having issues with BCBS MR Advantage paying G2211? I have received so many denials from them. I've appealed them on Availity and most are overturned, and a few denials have been upheld yet there's virtually no difference in the way they were billed. I'm spending a lot of time appealing when they just need to update their systems to allow payment. Any suggestions??
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I am in MN and we are having same problem with BCBS of MN