I sent this email to Soapm too:
Our office has some questions to clarify the G2211 code and the fact that many visits are now not qualifying for its use!
So, according to many sources, you can not add G2211 if there is a 25 modifier on the EM visit code.
The problem is these examples:
A 99214 visit where a flu vaccine is also given.
An example is in the Coding newsletter April 2024:
“An adolescent patient presents to a physician for follow-up of type 1 diabetes. During the office visit, the physician notes that the patient has not received immunization against influenza or
COVID-19 and recommends immunization at this visit. The patient and parents agree, and a medical assistant administers the immunizations. The physician reports an office visit code (eg, 99213 25) and codes for the immunization administrations (90460, 90480) and vaccine products (eg, 91322, 90688) but does not report G2211. “
Many visits this time of year will have a vaccine or in house strep test, etc and all these visits will not be able to have the G2211? What is being done to correct this?
Has anybody figured a work around?
The same issue states “The Medicare program places limitations on reporting G2211. Importantly, G2211 is not reported with an E/M service when modifier 25 (significant and separately identifiable E/M service) is appended to the related E/M code. This means that G2211 is not reportable when services like immunization or medication administration or minor procedures are reported by the same physician or QHP on the date of the related E/M service.”
So here is where a “minor procedure” could be a rapid strep test, etc.
Example:
99214-25
87880-qw (rapid strep test)
So if doing a rapid strep, can not add the g2211. Seems like we will lose over 50% of the opportunity to get reimbursed with the G2211.
Last scenario:
Saturday visit:
99213-25
99051- Sat code with modifier
Then can not add the G2211- even though we are seeing on a weekend as a PCP?
What the heck?
Please help!
Sharon Novy MD
Children’s Oasis Pediatrics
Gilbert, AZ