QWhat is a G2211 code?

A
Jill Cowan, FNP-BC

Jill Cowan, FNP-BC

DOCS Dermatology
Cincinnati, OH

Medically reviewed by Nicholas Brownstone, MD

On January 1st, 2024, the Healthcare Common Procedure Coding System (HCPCS) initiated a new add-on code G2211. Per Centers for Medicare and Medicaid Services, this code is used for “visit complexity inherent to evaluation and management associated with medical care 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.” Important to note, this is an add-on code that is listed separately to the office/outpatient E/M visit for new or established patients.

When to use or not use the add-on code:

  • This code can be used in the following scenarios:             
    • You are the focal point for all needed services
    • You are providing ongoing care for a single, serious condition, or a completed condition
  • This code cannot be used:
    • When a modifier-25 is used on the same date of service

In terms of documentation needed to support use of the code, CMS has not specified any additional medical record documentation requirement. Their medical reviewers may review the documentation in the medical record to confirm the necessity of this code.

How is a “serious or complex” condition defined? As of now, there is no specific diagnosis required for HCPCD code G2211. However, it may be beneficial to add in the documentation that the condition being treated, per CMS, is “a single, serious condition and/or a complex condition for which the billing practitioner is engaging the patient in a continuous and active collaborative plan of care related to an identified health condition.

How often does the patient need to be seen? No specific definition of “longitudinal” care has been defined by CMS. The provider needs to take responsibility for ongoing medical care for a patient with consistency and continuity over time.

References:

  1. HCPCS G2211 FAQ (PDF). (n.d.). https://www.cms.gov/files/document/hcpcs-g2211-faq.pdf