Understanding the Evaluation and Management Add-on Complexity Code
On January 1, 2024, the new add-on complexity code for evaluation and management (E/M) services, G2211, went into effect. Understanding appropriate use of this code and how it can and cannot be utilized is of importance for all physicians. This article discusses the nuances of this code and gives examples of how to effectively incorporate it into practice.
PRACTICE POINTS
- The add-on code G2211 went into effect on January 1, 2024, and can be applied to outpatient evaluation and management visits that fulfill certain criteria.
- This code should be utilized when one is serving as the continuing focal point for all of the patient's health care needs or providing ongoing medical care related to a patient’s single, serious or complex condition.
Example 5
A 6-year-old girl presents to a dermatologist for a new rash on the trunk that started 5 days after an upper respiratory infection. The dermatologist evaluates the patient and identifies a blanchable macular eruption on the trunk; the patient is diagnosed with a viral exanthem. Because the patient reported associated pruritus, topical triamcinolone is prescribed.
Would use of G2211 be appropriate for this visit?—No, in this case it would not be appropriate to bill for G2211. A viral exanthem would not be considered an ongoing single, serious or complex condition and would be more consistent with a discrete condition; therefore, even though the dermatologist is primarily managing the disease process, it still would not fulfill the criteria necessary to bill for G2211.
Final Thoughts
G2211 is an add-on code created by the CMS that can be utilized in conjunction with an outpatient E/M visit when certain requirements are fulfilled. Specifically, this code can be utilized when the dermatologist is the primary provider of care for a patient’s ongoing single, serious or complex condition or serves as the continuing focal point for all of the patient’s health care needs. Understanding the nuances associated with this code are critical for correct billing.
