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?

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

Duration - 60 minutes | Speaker - Toni Elhoms

Split/shared services are one of the most misunderstood categories of billing and reporting. For evaluation and management (E/M) visits jointly furnished by a physician and NPP in the same group practice in a facility setting, CMS has historically allowed the visit to be billed under the physician's NPI. However, all of that changed in 2022 and 2023 (transitional years) with updated rules that disallowed this practice and required the visit to be billed under the NPI of the physician or NPP who either documents the history, exam, or medical-decision-making for the visit OR whoever provides more than 50% of the total service time. In 2024, the changes are even more drastic, now requiring the visit to be billed under the NPI of the individual who provides more than 50% of the total visit time. This changes everything about how these encounters are billed and dramatically impacts physician RVU allocation. The 2024 split/shared service updates will have a massive impact on providers' clinical documentation and reimbursement rates.

Webinar Objectives:

The session aims to provide insights into the new 2024 split/shared visit rules in the facility setting, as announced by the Centers for Medicare & Medicaid Services (CMS). These groundbreaking changes are set to have a substantial impact on Medicare reimbursement, affecting both hospital-employed providers and physician practices utilizing non-physician practitioners (NPPs) in the facility setting.

Webinar Highlights:

• Discuss the major 2024 Split/Shared Service Reporting Requirements
• Review appropriate billing and reporting protocols for 2024 Split/Shared Service Updates
• Dissect the proper NPI submission requirements for 2024 Split/Shared Services
• Outline the new clinical documentation requirements for 2024 Split/Shared Services
• Highlight workflows and roles affected by the changes for 2024 Split/Shared Services
• Discuss financial impacts of the for 2024 Split/Shared Service Updates
• Walk through various split/shared service case studies to determine proper billing and reporting under the new 2024 rules
• Share best practice tips for Split/Shared Services in 2024

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

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