Medicare physician final rule introduced multiple new billing opportunities for physician practices such as value-added care for patients needing long-term treatment of complex patients (G2211). This add-on code provides additional payments to providers' long-term monitoring and developing an ongoing relationship with their complex patients. G2211 has not been without confusion on when and how to report.  Another opportunity is for evaluating patients who may have social issues impacting their healthcare (G0136) as well as helping these patients overcome these issues through trained personnel, G0019, and G0022 Community health integration (CHI) services.

Caregiver training (96202, 96203, 97550, 97551, and 97552) using a wide range of auxiliary personnel. Lastly, Principle Illness navigation (PIN) (G0023, G0024, G0140, and G0146) is a new billing opportunity for helping patients diagnosed with high-risk conditions — e.g., cancer, mental health conditions, substance use disorder (SUD), etc identify and connect with appropriate practitioners and providers in a timely manner for care and support resources.

Learning Objectives:-

• Understand the concept behind G2211 and the circumstances when G2211 can and cannot be reported.
• Documentation to support billing G2211
• Patient circumstances that may support billing SDOH (G0136)  
• Required follow-up when identifying patient-specific SDOH issues.
• Appropriate caregiver training providers
• Frequency of allowed caregiver services
• Requirements for reporting “incident to” for caregiver trainer,  CHI, and PIN services
• Reduce denials and/or compliance risks 

Areas Covered:-

• Longitudinal Care Definition
• Documentation to support G2211, SDOH G0136, G0019, G0022, 96202, 96203, 97550, 97551 and 97552, G0023, G0024, G0140 and G0146.
• Differences in reporting PIN services G0023/G0024 and G0140/G0146.
• Providers that may provide all of the above services.
• Forms to report SDOH

Who will Benefit:-

• Physicians and QHP Providers
• Office managers
• Coders
• Auditors
• Denial resolution teams
• Insurance payers