Here’s a sampling of the new G codes that represent physician services, along with some expert analysis:
G2211 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 (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
Analysis: CMS estimates in the 2021 Medicare Physician Fee Schedule final rule that specialties relying on evaluation and management (E/M) services “will use this code 90 percent of the time in conjunction with an office/outpatient visit E/M code.”
G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT® codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416) (do not report g2212 for any time unit less than 15 minutes)
Analysis: Medicare wants coders to use G2212 to represent prolonged services, instead of new CPT® add-on code +99417 Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services), but only with the following level 5 office/outpatient E/M services:
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter
99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family
“Private payers’ policies on this service may differ, so it will be important to check whether +99417 or G2212 should be reported,” says Witt. The guidelines for G2212 are similar to CPT® code +99417, “except CMS made clarifications to the language in the code description that it found unclear, such as the terms ‘total time’ and ‘usual service,’” says Witt.
G2213 Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)
Analysis: Witt reports that this is a code that you can report with other emergency department codes representing initial care: 99281–99285.
G2250 Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
G2251 Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
Analysis: These are temporary telehealth codes for providers who cannot bill independently for E/M services. After the COVID-19 public health emergency is over, Medicare intends on deleting these codes, explains Witt.
G2252 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
Analysis: “The code is intended for situations when the acuity of a patient’s problem is not necessarily likely to warrant an in-person visit, but when additional time is needed to make this assessment,” says Witt. “Medicare will decide later whether to make this code a permanent telehealth service.”
Other New G codes added in 2021
G2173 URI episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
G2174 URI episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to or on the episode date
G2175 Episodes where the patient had a competing comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
G2176 Outpatient, ED, or observation visits that result in an inpatient admission
G2177 Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to or on the episode date
G2178 Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer’s, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation
G2179 Clinician documented that patient had medical reason for not performing lower extremity neurological exam
G2180 Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
G2181 BMI not documented due to medical reason or patient refusal of height or weight measurement
G2182 Patient receiving first-time biologic disease modifying anti-rheumatic drug therapy
G2183 Documentation patient unable to communicate and informant not available
G2184 Patient does not have a caregiver
G2185 Documentation caregiver is trained and certified in dementia care
G2186 Patient/caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
G2187 Patients with clinical indications for imaging of the head: head trauma
G2188 Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
G2189 Patients with clinical indications for imaging of the head: abnormal neurologic exam
G2190 Patients with clinical indications for imaging of the head: headache radiating to the neck
G2191 Patients with clinical indications for imaging of the head: positional headaches
G2192 Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
G2193 Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
G2194 Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
G2195 Patients with clinical indications for imaging of the head: occipital headache in children
G2196 Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
G2197 Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
G2198 Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
G2199 Patient not screened for unhealthy alcohol use using a systematic screening method, reason not given
G2200 Patient identified as an unhealthy alcohol user received brief counseling
G2201 Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
G2202 Patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
G2203 Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
G2204 Patients between 50 and 85 years of age who received a screening colonoscopy during the performance period
G2205 Patients with pregnancy during adjuvant treatment course
G2206 Patient received adjuvant treatment course including both chemotherapy and HER2-targeted therapy
G2207 Reason for not administering adjuvant treatment course including both chemotherapy and HER2-targeted therapy (e.g. poor performance status (ECOG 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
G2208 Patient did not receive adjuvant treatment course including both chemotherapy and HER2-targeted therapy
G2209 Patient refused to participate
G2210 Risk-adjusted functional status change residual score for the neck impairment not measured because the patient did not complete the neck FS PROM at initial evaluation and/or near discharge, reason not given
G2211 has been postponed until 2024.
Thank you for giving the updated information.