ACP Provides Practice Resources to Help Physicians Best Utilize the New G2211 Add-On Code

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The ACP Coding Resource Hub offers guidance and a video supplement that explains how and when to use the code

April 5, 2024 (ACP) -- Following advocacy by the American College of Physicians and other organizations across health care, a new add-on code debuted this year with the aim of improving reimbursement for the longitudinal care of complex patients. Now, ACP is helping members to take advantage of this positive development by understanding how and when to use the G2211 code.

"The College has created a Resource Hub to ensure that physicians are properly reimbursed, and the new code becomes a streamlined part of the billing process," said Dejaih Johnson, ACP manager of regulatory affairs. "The College encourages physicians to educate their administration and coding professionals about the importance of G2211, and physicians should ensure they've updated their billing software and electronic health records to capture this service."

As Johnson explained, the Centers for Medicare & Medicaid Services implemented the G2211 code to better recognize the work of physicians when they establish meaningful relationships with patients and provide continuity of care for complex conditions.

"Before the implementation of G2211, the resource costs associated with primary care and longitudinal management of complex patients -- services such as chronic disease management tracking, review of consultative or diagnostic reports and medication monitoring -- were not fully accounted for in the current evaluation and management (E/M) coding structure," Johnson said. "Clinicians often bear a cognitive load, responsibility and accountability for building the most effective, trusting relationship possible with patients. This new G2211 add-on code will help make sure clinicians receive payment for this work."

The G2211 code is intended as an add-on code when clinicians report an office visit E/M code via a claim. "A longitudinal relationship is key," Johnson said, "and Medicare defines two longitudinal relationships that qualify: Either the clinician has or intends to have a long-term, ongoing relationship to care for a patient's serious or complex condition, or the clinician is the continuing focal point for all the patient's needed services, such as a primary care physician. Physicians must remember that while there are no special documentation requirements, the medical record should demonstrate medical necessity and confirm the provision of longitudinal care, resulting in a personalized plan for that patient."

ACP is working with private payers to confirm coverage of G2211 and to gather additional coverage information based on each plan's payment rules and policies. "Physicians must remember that the total impact on reimbursement and physician compensation formulas will depend on variations in contracting and payer arrangements," Johnson noted.

In addition, ACP is working with CMS to further refine the use of the code. "One area we are looking at closely is Medicare's prohibition on reporting G2211 when modifier -25 is used with the E/M service on the same day," Johnson said. "ACP is mindful not to unintentionally erect a barrier to good quality care by not allowing the additional payment for G2211 when modifier -25 is appended. G2211 was a major accomplishment for the College, and in recognition of the valuable care provided in these visits, we want to be sure that we do not incentivize fragmented care by preventing physicians from receiving the resources needed to account for comprehensive services that may be provided in a single visit."

ACP is also concerned that a similar challenge exists regarding Medicare's prohibition on reporting G2211 with an annual wellness visit. "We know that patients routinely appear for appointments with many needs, and physicians should not be denied payment for delivering comprehensive care alongside an annual wellness visit," Johnson said.

Meanwhile, ACP is expanding its offerings to members regarding the code. "As part of the College's Coding for Clinicians learning series, ACP will soon offer a learning module that will go into greater depth and cover additional aspects of billing and reimbursement," Johnson explained.

She strongly encourages members to review the ACP informational sheet and video supplement to learn more about use of and reimbursement for G2211.

More Information

The ACP Resource Center on Coding is available on the ACP website.

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