Understand The Difference in Level 3 & Level 4 Office Visits, Split/Shared Visits in 2024 & All About Code G2211

Session 1 - Auditing Office E&M Services – Is it a Level 3 or Level 4?

Pre-recorded Webinar

Duration - 60 minutes

Speaker - Jill M. Young

In 2021, significant changes were made in CPT for the code set Office and Other Outpatient Services.  In addition to changing the requirements for the history and physical exam, level of service is now determined exclusively based on a new Elements of Medical Decision-Making Table or on the total time of the visit (time spent on allowed activities). 

Since the change occurred, many providers struggle to determine if a visit has Low or Moderate Medical Decision Making (MDM), which correspond to a level three or level four visit. This webinar will offer easy to follow examples of the subtle differences that can occur between the two levels.  

Webinar Objectives

The key to discerning the difference between moderate and low medical decision making is understanding the individual components of the table of the Elements of Medical Decision Making. 

There are components of the table that the AMA gave great information on.  Unfortunately, other parts are not as well defined.  Neither by CPT in their Guidelines nor by AMA in its release of information prior to the release of the 2021 CPT books. 

In order to distinguish the difference between a level 3 and level 4 office visit, one needs to understand each of items in the Elements of Medical Decision Making. 

Webinar Highlights

• Overview of AMA’s document on the changes to Office & Other Outpatient Services in 2021
• Overview of the table of Elements of Medical Decision Making
• Requirements of moderate and low medical decision making
• Practical application of the requirements of MDM
• Sample scenarios

Session 2 - Split Shared in 2024 - What CPT Changes mean vs Medicare's rules

Pre-recorded Webinar

Duration - 60 minutes

Speaker - Jill M. Young

The working definition of what a split/shared visit is, has been the cause of many discussions in the past several years.  CMS/Medicare had very specific points they needed addressed that the Guidelines in CPT did not cover.  Items whether the two practitioners had to be in the same group, or if the practitioner who was the billing provider had to perform the substantive portion of the visit, or what locations split/shared visits were allowed at.   There were two sets of rules or guidelines for these services between a physician and a nurse practitioner or physician assistant.  In 2024, CPT redefined split/ shared visits with more clarity in their guidelines.  CMS/Medicare announced they were following CPT Guidelines.  They also announced use of the FT modifier is required for all these visits.  CMS/Medicare have recently given the Medicare Administrative Contractors, some additional guidance for these visits, that may cause you to re-evaluate how your practice performs and documents these shared visits.  Do you know about them?

Webinar Objectives

The objective of this webinar is to give participants the most up to date information available regarding split/shared visits.  Although CMS/Medicare has indicated they are following CPT guidelines, there is still room for defined differences.  Areas where CPT is silent, but CMS/Medicare has opinions.  Various MACs have differing information on their websites about this. 

This session hopes to give you a well-defined definition of the documentation of and practical use documentation of split shared visits.

Webinar Agenda

Split/shared visits

• CPT definition in 2024
  • CPT Guidelines
• CMS/Medicare definition in 2024
  • CMS’s “clarifications”
• Critical Care – why is it different

Webinar Highlights

• What changes did the AMA make to CPT guidelines for split/shared visits in 2024
  • For visits
  • For Critical Care visits
• CMS Medicare
  • from the Federal register on the 2024 PFS Final Rule
    • what are CMS/Medicare guidelines for Split shared
    • what are the differences from CPT
• Practical application of split shared rules in an outpatient and in patient setting

Session 3 - G2211 - A Boost to Primary Care and other Physician's Revenue Streams, Understanding the Requirements of the Code

Pre-recorded Webinar (Instant Access)

Duration - 60 minutes

Speaker - Jill M.Young

The add on code for office complexity, G2211, was approved by Medicare in the 2020 Physician Fee Schedule Final Rule but a moratorium was placed on payment for this code until 2024.  In the interim, further refinements to the HCPCS descriptor were made in clarification.  It was not felt that the value associated with a traditional office visit accounted for additional resources that were associated with a patient’s care in a longitudinal nature. 

Effective January 1, 2024 this code was payable as an add on code to Office and Other Outpatients codes.  The 2024 Physician Fee Schedule Final rule indicated that appropriate use of the code depended on the relationship between the physician and the patient. 

To date we have some additional information on documentation and use of this code that was designed for, but not limited to, primary care physicians. Understanding how to use the G2211 code, when to use it and how to document it are important steps an office needs to understand if they intend to bill for this service.

Webinar Objectives

Although this code has been around for several years, the practical application of it can be confusing.  The intention of the code is to give additional reimbursement to primary care physicians for the additional care elements that they experience in being the “lead” physician for patients.

Webinar Agenda

• The origins of the G2211 code will be explained and its journey into becoming a payable code effective January 1, 2024.
• Next, discussion around when to bill this code and what documentation is needed in doing so.
• Who can bill this code is another consideration along with how often the code can be utilized. 
• Finally, modifier use with the G2211 code will be discussed

Webinar Highlights

• History of the G2211 code
• What did we discover about the code in the 2024 PFS Final rule
• Are there frequency limitations
• Who can bill the code
• What documentation is required
• Where to find more information

Who Should Attend

Coders, Billers, auditors, Office Managers, Administrative Assistant’s, Physicians, practice managers, Nurse Practitioners, Physician Assistants, Physicians