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The G2211 coding alert has been updated based on further clarification of documentation requirements from CMS that was published in mid-January. Of note:
Documentation Requirements:
You must document the reason for billing the O/O E/M visit. The visits themselves would need to be medically reasonable and necessary for the practitioner to report G2211. In addition, the documentation would need to illustrate the medical necessity of the O/O E/M visit. We haven't required additional documentation. Our medical reviewers may use the medical record documentation to confirm the medical necessity of the visit and the accuracy of the documentation for billing code G2211:
- Information included in the medical record or the claims history for a patient/practitioner combination, such as diagnosis
- The practitioner's assessment and plan for the visit
- Other service codes billed
Patient Coinsurance and Deductible:
We pay for G2211 using the Physician Fee Schedule, and patient coinsurance and deductible apply.
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