Code professional services like a pro to maximize reimbursement in 2021.
The first quarter update to the HCPCS Level II code set includes 83 new codes, 76 revised codes, and 174 deleted codes. The majority of movement in the HCPCS Level II update for 2021 involves the G codes, Procedures & Professional Services.
The Centers for Medicare & Medicaid Services (CMS) added 50 G codes effective Jan. 1; seven are for physician services and assigned relative value units (RVUs), meaning providers can bill Medicare and get paid for these codes, as appropriate.
Check Out 2021 HCPCS Level II
HCPCS Levell II codes “help providers of Medicare, Medicaid, and various third-party insurances get paid for services that are not covered by CPT® codes,” explains Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, N.J. Therefore, Brink advises, it is critical to stay current with HCPCS Level II updates.
There are more than 15 different types of HCPCS Level II codes, ranging from A codes for Transportation, Medical & Surgical Supplies, Diagnostic and Therapeutic Radiopharmaceuticals to V codes for Vision/Hearing Services.
As of Jan. 1, Medicare recognizes 1,278 HCPCS Level II G codes, explains Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.
NOTE: The Consolidated Appropriations Act, 2021, signed into law on Dec. 27, 2020, disallows payment for G2211 until Jan. 1, 2024.
Watch Out for Changes to Office E/M Coding
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.”
Chronic Care Management Coding Is Changing
CMS also deleted several G codes they previously paid on, including:
G0297 Low dose CT scan (LDCT) for lung cancer screening
G2058 Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure) (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month) (use G2058 in conjunction with 99490) (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)
Analysis: According to Moore, G2058 was cut because CPT® 2021 introduced add-on code +99439 Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure). “Coders who used G2058 in 2020 will use +99439 in 2021,” Moore explains.
Use +99439 with primary service code 99490 Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
For More Information: https://www.aapc.com/blog/52806-focus-on-g-codes-for-medicare/