CMS introduces a new complexity code for Infectious Disease, G0545, and makes changes to the G2211 complexity code effective January 1, 2025.
G2211 - Visit complexity code is to be used by any provider, regardless of specialty, when the provider/patient longitudinal care relationship exists or is in the process of being established. CMS confirmed that longitudinal care is established by the specialty/subspecialty, not necessarily each individual provider, within the same group. This code may be billed with new or established patient office visits only (99202-99215). In 2024, the G2211 cannot be billed when another service is provided on the same day by the same provider/specialty.
What’s changing for 2025? The G2211 may be billed with a new or established office visits (99202-99215) when a covered Medicare Preventive Service is performed on the same day. This includes such services as the Initial or Subsequent Annual Wellness Visit (AWV) or the Initial Preventive Physical Exam (IPPE) and more. Please refer here to view Medicare’s interactive tool to identify covered preventive services.
NEW Complexity Code for Infectious Disease Specialists
G0545 - Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and/or complex antimicrobial therapy counseling and treatment. (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge.
Who can bill this code?
Faculty and APPs with specialized training in infectious diseases who can bill Evaluation and Management Codes may bill G0545 when treating the patient with a documented confirmed or suspected infectious disease. This is an add-on code to the following codes:
- Hospital Inpatient or Observation Care
- Initial – 99221-99223
- Subsequent – 99231-99233
- Discharge – 99238-99329
- Same Day Admit and Discharge – 99234-99236
CMS will verify the proper use of this code with supporting documentation of a confirmed or suspected infectious disease diagnosis along with the assessment and plan.
Revenue Cycle Financial Clearance working in conjunction with Coding Education to bring you information to manage the patient experience for all patients at UTMB. We are dedicated to the education and success of all UTMB providers. Please contact The RCO Financial Clearance and Coding Education Team to ask questions or schedule a meeting. We are here to help! Email the Coding Education Team. |