First Coast Service Options Issues Guidance for Avoiding Code G2211 Denials
According to First Coast Service Options, Inc., the Medicare Administrative Contractor (MAC) for Florida, Puerto Rico and the U.S. Virgin Islands, has been receiving a flood of appeals requests for denials of HCPCS code G2211 when billed with an office and outpatient (O/O) E/M service (CPT® codes 99202-99205 and 99211-99215) appended with modifier 25 because National Correct Coding Initiative (NCCI) edits do not apply in this scenario.
The Centers for Medicare and Medicaid Services (CMS) have implemented edits, which instruct the MACs to deny these types of claims. These denials are not related to NCCI edits.
HCPCS code G2211 is a new E/M O/O add-on code used to report visit complexity when reported with CPT® codes 99202-99205 and 99211-99215. The O/O E/M visit complexity add-on code G2211 is not payable when reported with the O/O E/M visit appended with payment modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service). Separately identifiable visits performed on the same day as minor procedures (such as 0- or 10-day global procedures) have “resources sufficiently distinct from costs associated with furnishing standalone O/O E/M visits to justify different payment.”
The MAC recommends the following to avoid code G2211 denials:
- Do not report code G2211 when modifier 25 is reported on an associated E/M visit (CPT® codes 99202- 99205 and 99211-99215);
- Do not use modifier 25 with HCPCS code G2211;
- Do not use modifier 25 with CPT® code 99211;
- Do not use modifier 25 by a physician other than the physician performing the procedure; and
- Do not use modifier 25 when documentation does not support a significant, separately identifiable E/M service.
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