G2211?

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I spoke with Noridian who manages our Medicare claims. They stated that G3002 CAN be billed with E/M, which we knew. The rep couldn't clarify the conditions that would make them eligible to bill together. I did submit a test claim with both E/M and G3002, both of which paid (on an encounter where I did have to spend more than 30 minutes). But I'm not going to submit both regularly (since I don't regularly spend 30 minutes anyways, but also because I still think it's double-dipping and would not pass an audit when used by pain management specialists).

On the other hand, I've been submitting G2211 regularly with E/M. They've been paying consistently for both and I think we are well within reason to bill G2211 on almost every E/M encounter based on both mine and my billers interpretation of the coding criteria.
 
IAmTheOne1 said:
I spoke with Noridian who manages our Medicare claims. They stated that G3002 CAN be billed with E/M, which we knew. The rep couldn't clarify the conditions that would make them eligible to bill together. I did submit a test claim with both E/M and G3002, both of which paid (on an encounter where I did have to spend more than 30 minutes). But I'm not going to submit both regularly (since I don't regularly spend 30 minutes anyways, but also because I still think it's double-dipping and would not pass an audit when used by pain management specialists).

On the other hand, I've been submitting G2211 regularly with E/M. They've been paying consistently for both and I think we are well within reason to bill G2211 on almost every E/M encounter based on both mine and my billers interpretation of the coding criteria.
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Do you know if any commercial insurances are paying G2211?
 
Doctodd said:
update? G3002 seems more appropriate on it's face.
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Independent coder/auditor said can be billed but you, the doctor, has to spend 30 min with patient and MA time does not count.
 
since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi
 
CleanUp said:
since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi
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Isn't that just part of MDM? What is the separate code you use?
 
CleanUp said:
since this thread is about getting reimbursed for things we’re already doing I didn’t know but interpreting X-rays carry a surprising amount of RVUs fyi
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I’m assuming this is for in office X-rays without a radiologist read? I thought otherwise an independent interpretation of an xray read by a radiologist was just a part of E and M
 
Asclepius186 said:
I’m assuming this is for in office X-rays without a radiologist read? I thought otherwise an independent interpretation of an xray read by a radiologist was just a part of E and M
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You are correct I am reading the film not a radiologist. I am clear the date it was taken, the date it was interpreted, and my impression.
GatorCHOMPions said:
Isn't that just part of MDM? What is the separate code you use?
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I was told it is separate because I am interpreting the film without a radiologist. For example lumbar 4 views 72110

Others found here https://rbarad.com/wp-content/uploads/2021/03/19-RBA-0011-RBA-X-Ray-CPT-Codes_2021.pdf
 
BobBarker said:
I think that is appropriate to read your own films and bill for it like ortho does as long as you have a diagnostic X-ray in your office and a PACs to store the films.
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Correct that’s what I do just like ortho.

I figure I am taking the med legal risk so might as well get some reimbursement.
 
BobBarker said:
I think that is appropriate to read your own films and bill for it like ortho does as long as you have a diagnostic X-ray in your office and a PACs to store the films.
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This is what I do.

Spine and joints. I read my own XRAYs and bill for them.
 
This is reasonable, but just don’t miss a tumor. Or ankylosing spondylitis. Or a bunch of other stuff.

You are taking on a fair amount of risk if you read you own X-rays. There’s more to miss along the spine than in knees and shoulders
 
SSdoc33 said:
This is reasonable, but just don’t miss a tumor. Or ankylosing spondylitis. Or a bunch of other stuff.

You are taking on a fair amount of risk if you read you own X-rays. There’s more to miss along the spine than in knees and shoulders
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I agree with your point about more to miss in the spine than the knees and shoulders. However, practically speaking, for those who work in a ortho group it is standard culture to get X-rays in office. Most people will end up getting MRIs.

I have a few times been concerned about the scary things and I will get additional imaging which is of course read by a radiologist.
 
I took @drrosenrosen blurb and turned it into this:

"This patient is being managed for a complex chronic pain that requires ongoing medical management. The nature of this condition requires a longitudinal relationship and monitoring over time for appropriate treatment." My biller says we haven't received any denials yet (started 2nd week of January) but she is still waiting on the EOBs.
 
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IAmTheOne1 said:
I spoke with Noridian who manages our Medicare claims. They stated that G3002 CAN be billed with E/M, which we knew. The rep couldn't clarify the conditions that would make them eligible to bill together. I did submit a test claim with both E/M and G3002, both of which paid (on an encounter where I did have to spend more than 30 minutes). But I'm not going to submit both regularly (since I don't regularly spend 30 minutes anyways, but also because I still think it's double-dipping and would not pass an audit when used by pain management specialists).

On the other hand, I've been submitting G2211 regularly with E/M. They've been paying consistently for both and I think we are well within reason to bill G2211 on almost every E/M encounter based on both mine and my billers interpretation of the coding criteria.
Click to expand...

Following up on this. Is anyone adding the G3002 to their E/M visits? What's the catch? That's a nice additional chunk of RVU.


Can we be adding that to initials and follow-ups, providing we see patients for that duration? Or am I misunderstanding, and it's either/or, not both E/M (say, 99204 + G3002)?

This article seems to suggest yes, but when the E/M and the G3002 deal with different aspects of the visit.
healthcare.trainingleader.com

G3002: Make the Chronic Pain Management Codes Work for You

The new chronic pain management codes, G3002-G3003, can help your practice collect for these time-intensive services in 2023. Get the scoop on how to report the codes properly to reduce Medicare denials.
healthcare.trainingleader.com healthcare.trainingleader.com

You Can Report CPM and E/M Codes on the Same Day​

If the provider performs chronic pain management and a standard office visit on the same date, you can report both services, as long as you don’t count the time and the effort twice.

Example: An established patient presents to evaluate her hypertension, diabetes, and chronic pain. The physician spends 25 minutes on the E/M portion of the service and discussing medications and lifestyle changes related to hypertension and diabetes. She then spends 30 minutes dealing with pain management. In this case, you’d report:

  • 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter; 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)
  • One unit of G3002.
Click to expand...
 
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drg123 said:
Following up on this. Is anyone adding the G3002 to their E/M visits? What's the catch? That's a nice additional chunk of RVU.


Can we be adding that to initials and follow-ups, providing we see patients for that duration? Or am I misunderstanding, and it's either/or, not both E/M (say, 99204 + G3002)?

This article seems to suggest yes, but when the E/M and the G3002 deal with different aspects of the visit.
healthcare.trainingleader.com

G3002: Make the Chronic Pain Management Codes Work for You

The new chronic pain management codes, G3002-G3003, can help your practice collect for these time-intensive services in 2023. Get the scoop on how to report the codes properly to reduce Medicare denials.
healthcare.trainingleader.com healthcare.trainingleader.com
Click to expand...

I don't think you should routinely bill E/M + G3002; as stated, you cannot double count anything. I suppose if you are managing some non-pain things like insomnia/anxiety/depression and then also some MSK stuff you can count the 3002 (must be 30 mins) for the MSK stuff and then the E/M for the non-pain diagnoses.

G2211 on the other hand can and should be billed fairly routinely.
 
drg123 said:
Following up on this. Is anyone adding the G3002 to their E/M visits? What's the catch? That's a nice additional chunk of RVU.


Can we be adding that to initials and follow-ups, providing we see patients for that duration? Or am I misunderstanding, and it's either/or, not both E/M (say, 99204 + G3002)?

This article seems to suggest yes, but when the E/M and the G3002 deal with different aspects of the visit.
healthcare.trainingleader.com

G3002: Make the Chronic Pain Management Codes Work for You

The new chronic pain management codes, G3002-G3003, can help your practice collect for these time-intensive services in 2023. Get the scoop on how to report the codes properly to reduce Medicare denials.
healthcare.trainingleader.com healthcare.trainingleader.com
Click to expand...
Looked into it and the time requirements seem far beyond what I’d spend with a patient. I do bill G2211 with most Medicare patients though. It’s not a huge boost but it’s something.
 
So for the G3002 code, would this be a good option for those of us who still do some non-pain stuff?

Say, for example, I do some spasticity management and the pt also mentions that they have chronic low back pain? Would it be correct to bill the E&M as well as the G3002?
 
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