Ask the questions that come up between patients. Get a yes, a no, or a depends, with the phrase your note needs.
G2211 is for a visit that is part of ongoing care for a single serious or complex condition, or where you are the continuing focal point for all of the patient's needed services. Medicare does not pay it when the visit carries modifier 25 for a same day minor procedure (injections, biopsies, laceration repairs, cerumen removal, wart destruction), with exceptions for certain preventive services such as the annual wellness visit and vaccine administration. On visit-only days for a patient whose ongoing care you own, it belongs on every claim.
Evaluating the problem the procedure treats is part of the procedure, so the visit is separately reportable with modifier 25 only on one of two pathways. Same problem, work beyond the procedure: any one of these four, documented, is enough; list every one that applies.
Two diagnoses: one treated by the procedure, the other evaluated and managed as an E/M with its own clearly separated decision making (time-based coding is also available here). When both pathways apply, code the higher; this is the most audited scenario in procedural specialties, so the note has to show the separate work, not just claim it.
Routine care of the operative site is the package: 99024, no wRVU. A genuinely unrelated problem is payable with modifier 24, and the note must make the distinction obvious. Under Medicare a related complication managed without a return to the operating room is included in the global, a return to the operating room is the procedure with modifier 78 rather than a visit, and some commercial payers pay complication visits, so verify the payer.
G0447 pays for 15 documented minutes of intensive behavioral therapy for obesity (BMI 30 or above) alongside the visit, at a frequency Medicare defines. When obesity is managed only through the counseling you are coding, the counseling code is its credit; the same problem cannot also carry the visit level.
Examining and closing the cut is the repair code (12001 and its family), which is always yours. A separate E/M with modifier 25 is payable only for distinct evaluation: the head injury screened after the fall, the syncope workup behind the collapse, tetanus and neurovascular assessment documented as real evaluation beyond the wound. One repair rule: lengths of repairs in the same classification and site group are summed into one code, never coded as two small repairs.
On top of 99215 or 99205 selected by time, prolonged services add in full 15 minute units, and the thresholds differ by payer: CPT 99417 begins at 55 total minutes with 99215 and 75 with 99205; Medicare G2212 begins at 69 and 89. Documented exact total minutes are the whole game; a range is not a time.
99497 pays for the first 16 to 45 minutes of face to face advance care planning, and Medicare waives the patient's cost sharing when it is furnished on the same day as the AWV. Document the minutes and the voluntary nature of the discussion; forms do not have to be completed for the time to count.
A consult needs the three Rs: a documented request from another clinician with the reason, your opinion rendered, and a written report back to the requester. A transfer of care is not a consult. And for Medicare and many plans, new patient plus G2211 often outpaces the consult family anyway; run both before assuming.
The AWV (G0438 first, G0439 after) and a problem oriented E/M can be reported the same day when the problem work is separately documented; the E/M takes modifier 25. That can be three lines on the claim: the wellness visit, the E/M with modifier 25, and G2211 when the visit is part of ongoing care, which CMS allows alongside the wellness visit. If selecting the E/M by time, count only the minutes attributable to the problem visit, never the wellness work.
A preventive visit (99381 to 99397) plus a problem E/M with modifier 25 is legitimate when a problem needed its own history, examination, and decision: a new knee effusion worked up, uncontrolled blood pressure that forced a medication change, a new depressive episode that needed treatment. A refill, a reassurance, or a finding folded into the physical does not earn a second code. The patient may see cost sharing on the problem visit that the preventive visit alone would not trigger, so many practices say so at checkout.
99406 pays for more than 3 and up to 10 documented minutes (exactly 3 does not qualify) and 99407 beyond that, on top of the E/M, with no modifier 25 needed and G2211 still billable. The work is usually happening already; the minutes are what is missing.
Any product regulated as a tobacco product counts, burned or not: cigarettes, cigars, pipe, hookah, chewing tobacco, snuff, dip, snus, heated tobacco, nicotine vaping, and nicotine pouches. Cannabis and zero nicotine vaping do not; cannabis counseling needs a named screening instrument with its score plus 15 minutes, which is 99408 (Medicare G0396). Full rules are in the counseling chapter.
An in office ECG with your documented interpretation and report is separately reportable alongside the E/M (93000 with your equipment, 93010 for interpretation and report alone). A test you separately report cannot also count in the MDM data column, so the ECG pays as itself and the visit level stands on the rest of the encounter.
There is no sports physical code: a stand alone preparticipation exam is the age based preventive visit, 99381 to 99397, with diagnosis Z02.5, and many plans do not cover it, which is why it is often a flat cash fee. If the athlete is due for an annual preventive visit, do that visit, complete the form inside it, and report the preventive code alone. A real finding (a murmur, uncontrolled asthma, a healing fracture) is a separate E/M with its own diagnosis and modifier 25; full answer on the sports physical page.
Closed treatment without manipulation codes exist for exactly this, and they carry a 90 day global. The alternative is coding each visit as E/M instead; the better choice depends on expected follow up, and either is defensible when documented.
Since the 2020 descriptor revision, 29880 and 29881 include chondroplasty in the same or a separate compartment, and CMS NCCI states 29877 is not reported with knee arthroscopy codes 29866 to 29889. Medicare's G0289 applies only to loose or foreign body removal from a different compartment, not chondroplasty. Payer specific: a few commercial plans differ; check before appealing.