What is Happening?
The preliminary plans for the 2024 calendar year have been released. As a result, medical groups should brace themselves for rate cuts: the Centers for Medicare & Medicaid Services is proposing a net 3.4% drop in the Medicare Part B conversion factor.
After the proposed 2024 Medicare physician fee schedule was released on July 13th, CMS responded with a preview of new codes. This includes the reinstatement of the add-on office visit code G2211. Furthermore, the preview includes considerable updates to the quality-reporting system, and new potential for separate coding for “community health integration services.”
According to the rule, the conversion factor will drop by $1.14 from $33.8872 to $32.7476 in 2024. Should the plan pass, the conversion factor for anesthesia also suffers in 2024. It decreases by -3.3% from a proposed rate of $21.1249 in 2023 to $20.4370 in 2024.
Reintroduction of the Visit Complexity Code
The office visit add-on HCPCS code G2211 is back in use after being put on hold for years due to legislation passed in December 2020. Although G2211 was formerly included in the 2021 fee schedule, it will now be available January 1, 2024. Medicare changed the code’s A (active) status to B (bundled).
Additionally, in January CMS will grant G2211 active status and assign a code work relative value unit (RVU) of 0.33. An earlier estimate suggested that each claim would yield around $16 from the code. The government claims it is unknown how using the code will affect budget neutrality, but it does anticipate that 54% of all office E/M visits will include a report of the code.
What is Visit Complexity?
Visit complexity is the outcome of management and evaluation of medical care services, which are the primary focus of all necessary treatments and/or medical care services. In addition, they are a part of ongoing treatment for a patient’s single, serious, or complex disease. In a nutshell, G2211 refers to evaluation and management (E/M) appointments that are a continuous, longitudinal care relationship component. For both new and returning patients, you can specify this add-on code separately from office and outpatient (E/M) visits.
However, there are a few restrictions with the new code. According to the agency, the visit complexity code won’t be payable when an office visit is submitted with modifier 25 or combined with another service. The agency adds that there are some instances where the code “would not be appropriately reported, such as when the care furnished during the [office] E/M visit is provided by a professional whose relationship with the patient is of a discrete, routine, or time-limited nature,” using examples like “treatment of a simple virus; for counseling related to seasonal allergies; initial onset gastroesophageal reflux disease; treatment for a fracture; and where comorbidities are either not present or not significant.”
How Can MedCore Help Your Practice with This Change?
MedCore’s Medical Coders and Billers can help your practice with incorporating the new codes into your practice. To prevent billing problems, our Certified Medical Coders can help you standardize and precisely enter information. Billing mistakes are expensive, time-consuming, and detrimental to patient satisfaction. Likewise, the difference between successful and struggling medical practices is high-quality, professional medical billers. The medical billers at MedCore assist your clinic in managing payments, invoicing, and insurance claims. All healthcare organizations should take efforts to avoid medical billing errors if they haven’t already since medical coders and billers are so common.
Some are saying that G2211 will not be used every time a patient visits the office. However, billing errors are one of the most harmful ways that medical offices, hospitals, and clinics lose revenue. Also, the use of G2211 will improve how accurately primary care expenses are reflected, and MedCore’s medical coders can assist with this.
If you feel that the addition of a certified medical coder or medical biller will help your practice thrive with the newfound changes of 2024, contact our specialists today!
American Academy of Family Physicians. (2023, February 13). Academy renews push for Medicare add-on code. Retrieved from https://www.aafp.org/news/government-medicine/g2211-advocacy-renewal.html#:~:text=In%20the%20agency’s%20definition%2C%20Code,related%20to%20a%20patient’s%20single%2C
CMS. H3.Group. (2023, July 13). Fact sheet calendar year (CY) 2024 Medicare physician fee schedule proposed rule. Retrieved from https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
MedCore Solutions. Certified Medical Coders. (2023, April 25). Retrieved from https://medcoresolutions.com/certified-medical-coders/
MedCore Solutions. Medical billers. (2023c, April 25). Retrieved from https://medcoresolutions.com/medical-billers/