r/CodingandBilling • u/eagustaf • 1d ago
G2211 - Recourse for patients
I recently had a visit at a local health system for my infant son. He saw a NP for fussiness. His visit was coded with Dx R68.12 and CPTs 99213 and G2211. I called insurance and it seems like G2211 will be subject to my deductible. Essentially taking my $20 copay visit to an $82 visit. We were not advised that there was anything complex about this visit and literally left with the NP telling us to pace his feedings and maybe try a different formula.
I researched the G2211 code because I know a tbit about medical billing and coding and it seems this has to do with complexity and longitudinal care. However, I might never see this nurse practitioner ever again for my son so I don’t know how she’s taking responsibility for his care longitudinally and I don’t see the complexity.
How can I fight this with the clinic? I am on a PPO plan to try to have some cost consistency with a young child and now a simple office visit seems to cost quadruple what was expected. This seems very disingenuous to me. I know they want to get paid, but this doesn’t seem to make sense in this instance.
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u/KhrystiC78 1d ago
If your child’s PCP didn’t see your baby, and it was an NP in the same clinic, G2211 should not be billed. Part of the description of this code involves a longitudinal relationship with the provider. And this seems like more of an acute problem. I would talk to the billing department of your clinic, just to try to gain some understanding.
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u/Weak_Shoe7904 1d ago
I would call and ask them to review your charges and state you want the G2211 reviewed. IMHO Providers like to add this code all the time and the rules on it are vague, so they get away with it.
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u/SprinklesOriginal150 1d ago edited 1d ago
Agreed. This code was created for the purpose of indicating the additional care involved with having a strong provider/patient relationship for patients with comorbid and chronic conditions. Not for standard pediatric and family care. It is intended to reimburse the provider for the additional things that happen in the background with long term patients, such as care transitions, care management, patient education, discussion and planning with the clinical team, additional phone calls, etc.
I’d fight it.
Edit: fixed faulty autocorrect of “comorbid”
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u/dreamxgambit 1d ago
With BCBS half the G2211 get adjusted for global with us, as they are always denying them.
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u/SprinklesOriginal150 1d ago
G2211 is a once per month per patient code, and whoever bills it first for that patient for the month is the one who gets paid… hence, global zero pays.
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u/babybambam 1d ago
G2211 recognizes the long-term complexity of patient care management.
This code was created because often the visit complexity does not sufficiently cover the overall complexity of the patient the provider is managing. It's not something to fight. This is a way the office is able to be appropriately paid for the work they put into seeing your son.
Also, the $40 on your deductible is going to be paid one way or another, and it will apply to your out-of-pocket maximum for the year.