Cardiology office visit billing goes unpaid in 3 places. G2211, the Medicare add-on, often goes unbilled. The visit level and a same-day study are the other 2.
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New patient visits are 99202 to 99205, and established visits are 99212 to 99215. You level each by medical decision making or total time.
In cardiology, 99214 is the everyday level: 2 stable chronic conditions, plus prescription drug management. We level from the note, and tell the doctor when it supports less than the superbill.
A patient counts as established if your group, same specialty, saw them within 3 years. Medicare enrolls electrophysiology as its own specialty. So a first EP visit, even for a patient you follow, can bill at 99202 to 99205.
Prolonged time applies only when you code by time. 99417 starts at 55 minutes for an established visit. Medicare uses G2212, which starts later.
Coding and claimsG2211 is Medicare's add-on for ongoing care of a serious condition, like heart failure or atrial fibrillation. The note has to show the ongoing plan.
Medicare doesn't pay it when the visit carries modifier 25 for a same-day procedure. Many commercial plans don't pay it, so we send it only where the plan covers it.
99214, G2211
Visit and add-on, both billed
99214
Visit only, plan skips G2211
An echo, ECG or stress test bills with a same-day visit. The visit has to stand apart in the note. A procedure with a global period, such as cardioversion, needs modifier 25 on the visit.
4 things commonly deny a same-day visit:
We check all 4 before the claim goes out. When a denial still comes back, we correct or appeal it with your note.
EchoEach visit pays at the level your signed note supports. G2211 and prolonged time are add-ons, never billed alone.
| Code | What it covers |
|---|---|
| 99202 to 99205 | New patient visits |
| 99212 to 99215 | Established patient visits |
| G2211 | Medicare visit complexity add-on |
| 99417, G2212 | Prolonged services, CPT and Medicare |
| 93000 | ECG with interpretation, same day |
| 99242 to 99245 | Consultations, where a plan still pays them |
We show you which Medicare visits qualified for G2211, which carried it, and which were denied and why. Free, no strings.
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