New Coding When Caring For a Complex Condition

HCPCS 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[1]

When To Use

This code may be submitted when an office or other outpatient evaluation and management (E&M) service is performed and that E&M is:

  • Part of providing all needed health care services for that patient

And/or

  • Part of ongoing care related to a patient’s single, serious condition

And/or

  • Part of ongoing care related to a patient’s complex condition

G2211 may be submitted for either a new or established patient.

Add-on Code

When submitted, G2211 should be added to an office or other outpatient evaluation and management CPT® code.  It should never be submitted alone.  When an E&M is performed that meets the above criteria, the level should be selected using either medical decision making or total time.  After that process is complete and the level is determined, G2211 may be added to the E&M code if the above criteria met.

Documentation

If G2211 is added based on one or more of the three criteria listed above, it is recommended that that criteria be documented.  For example, if all of the other documentation supports the claim, the following sentence may be included:

“This E&M of this chronic ulcer was part of the ongoing care I am providing related to this complex condition.”

When Not To Use

One exception to all of the above is that G2211 may not be added to an E&M service that has a 25 Modifier appended to it.

[1] https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt/hcpcs-codes

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
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Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.