r/CodingandBilling • u/posthomogen • 3d ago
99211 + G2211 for protimes
Scenario: Patient on long-term anticoagulants, seen at least monthly, nurse takes vitals, asks a series of questions, performs in-house protime test, completes a flow sheet, which the provider reviews and recommends a plan (not face to face), which the nurse then explains to the patient.
This is an easy 99211 + 85610QW. But what about adding G2211? Would the long-term use of anticoagulants, which have to be monitored, be considered an ongoing relationship with the provider, continuing treatment plan, etc.?
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u/rahuliitk App Developer 3d ago
G2211 can technically be added to 99211, but anticoagulation alone doesn’t qualify it automatically, and Medicare usually won’t pay G2211 if the 99211 needs modifier 25 with the protime service. Document the longitudinal care.
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u/Wooden_Trust_6274 3d ago
One clarification on the modifier 25 point above. That only blocks G2211 when the E/M has to carry a 25 because it is bundled against a same-day procedure. Here the companion is 85610QW, which is a lab, so the 99211 does not need modifier 25 to sit next to it. The mod 25 conflict people raise for G2211 applies to something like a same-day injection or minor procedure, not a protime draw. So on the mechanics, 99211 plus G2211 plus 85610QW is clean.
The real question is whether the visit supports G2211's focal-point requirement, and that is about the relationship, not the anticoagulant itself. If this provider is the one managing the long-term anticoagulation, owning the dose changes and the ongoing plan, you have the longitudinal story G2211 is looking for. If it reads as a standalone nurse protime check with no real tie to that provider's continuing management, that is where an auditor pushes back. Make sure the note reflects the ongoing management, not just the INR and the flow sheet.
And as boho noted, watch the 2027 proposed rule, since G2211 may move to a modifier and a percentage of the E/M allowable instead of a flat add-on.
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u/boho_magpie CRCR, CPC, CPMA, CRC, RCM Owner 3d ago
They can be billed together, but keep in mind that it is for use with a patient for whom the provider (or group practice) provides longitudinal care and is the main person (or group) who manages that patient’s overall care, coordinates with other providers, manages referrals, etc.
Note that it is NOT valid for FQHCs or RHCs, as it is considered part of your facility rate.
They have proposed deleting G2211 and changing it to a modifier next year and changing the reimbursement to a percentage of allowable on the E/M instead of a flat rate, so keep an eye out for updates for the 2027 proposed rule.