From the Research
The G2211 code can be used for complex evaluation and management (E/M) visits that require additional time and medical decision-making beyond what is typically required, but it cannot be used with preventive visit codes, such as annual wellness visits (AWVs), as seen in studies 1, 2. When considering the use of the G2211 code, it's essential to understand that it is designed for visits that involve care for ongoing, chronic conditions that require continuous medication management, coordination among multiple providers or care settings, or addressing social determinants of health that complicate care delivery. This code is appropriate when patients have multiple chronic conditions requiring extensive care planning, when visits involve complex risk management decisions, or when patients need significant counseling about their conditions. Some key points to consider when using the G2211 code include:
- It can be used as an add-on to office or outpatient E/M codes (99202-99215) for complex visits
- It acknowledges the additional work involved in providing longitudinal, comprehensive care to patients with complex needs
- It cannot be used with preventive visit codes, transitional care management services, or certain other specialized services that already account for complexity in their base codes, as noted in studies 3, 4, 5 In the context of annual wellness visits (AWVs), which are preventive in nature, the G2211 code would not be applicable, as seen in the study 2, which focused on RN-led AWVs incorporating the 4Ms framework, and study 5, which discussed interprofessional Medicare Annual Wellness Visits for older adults. Key considerations for the use of the G2211 code include:
- The visit must require additional time and medical decision-making beyond what is typically required
- The visit must involve care for ongoing, chronic conditions that require continuous medication management, coordination among multiple providers or care settings, or addressing social determinants of health that complicate care delivery
- The code cannot be used with preventive visit codes, transitional care management services, or certain other specialized services that already account for complexity in their base codes.