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.
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.
