OBR OncologyHow Oncology Practices Can Ethically Boost E/M Payments

Navigating the Nuances of Enhanced E/M Reimbursement in Oncology: A Detailed Guide to Ethical Billing Practices

In the ever-evolving landscape of medical billing and coding, oncology practices now have an avenue to ethically enhance their evaluation and management (E/M) payments, thanks to Medicare’s introduction of code G2211. This comprehensive summary distills the crucial aspects of the new reimbursement policies, offering oncologists and their billing staff a clear roadmap to leverage these changes while maintaining compliance and fostering patient care continuity.

Key Points:

• Medicare has introduced add-on code G2211 in 2024, enabling oncology practices to increase their E/M payments under specific conditions.
• Code G2211 is applicable for E/M visits that are part of ongoing care related to a patient’s single, serious condition or a complex condition, highlighting the importance of a “longitudinal” patient-provider relationship.
• The use of G2211 is contingent upon the provider’s role as the continuing focal point for the patient’s healthcare needs, underscoring the code’s intent to compensate for the complexity inherent in managing ongoing patient care.
• CMS released detailed guidance on January 18, 2024, clarifying the application of G2211, which must be reported alongside an appropriate E/M visit code (99202–15) but not in instances where a procedure is performed with modifier 25.
• Providers are encouraged to meticulously document the longitudinal relationship and ongoing care provided to patients to justify the use of G2211, reflecting the comprehensive nature of the care management involved.
• Oncologists must verify each payer’s stance on G2211, as not all insurers may adopt this code for additional reimbursement beyond Medicare Part B.

“The complexity doesn’t come from the condition itself. Instead, it comes from the cognitive load of the continuing responsibility of being the focal point for that condition.”
– Barbara J. Cobuzzi, MBA, capturing the essence of the new code’s purpose and application

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