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Coding and payment

The importance of optimal coding and billing in ID care

Infectious diseases providers primarily bill under evaluation and management (E/M) codes, which represent billing for cognitive services, as opposed to procedures. Appropriate documentation and billing for E/M services are vital both for capturing the medical services provided to patients and for ensuring appropriate reimbursement and compensation.

In addition to E/M, other codes exist for ID providers to optimally bill for patient care services in the appropriate settings, such as an inpatient add-on code (G0545), outpatient add-on code (G2211) and billing for critical care services.

The resources on this page are intended to help the ID clinician optimally bill for patient care services by educating them on both E/M codes and additional billing tools.”

 

  

In the Know

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G0545

  • Add-On Code (G0545) link

    The new ID add-on code, G0545, went into effect on Jan. 1, 2025. This code is available for infectious diseases specialists to report additional complexities in hospital evaluation and management services. In this webinar, Drs. Amy Kressel and Asher Schranz discuss the G0545 code and how to use it.

  • G0545 Q&A Resource pdf

    To further support ID specialists, we have compiled a Q&A resource addressing questions asked during the G0545 webinar. Whether you attended the webinar or are looking for additional guidance, this Q&A is a helpful reference for effectively navigating the new add-on code G0545.

  • FAQs for ID Add-On Code G0545 pdf

    Find answers to frequently asked questions about the new G0545 code.

  • ID Add-On Code G0545 Infographic pdf

    To help ID specialists navigate the proper use of add-on code G0545, IDSA has created an infographic checklist outlining the key criteria that must be met (one from each section MUST be met). This visual guide serves as a quick reference to ensure proper usage. Use this checklist to verify that all necessary requirements are met before applying the code. IDSA will continue to update the resources on this page for code G0545 as CMS provides further clarification.

G2211

  • Code G2211 Fact Sheet pdf

    All medical professionals who can bill office and outpatient evaluation and management visits (CPT codes 99202-99205, 99211-99215), regardless of specialty, may use the code with O/O E/M visits of any level. We don’t restrict G2211 to medical professionals based on specialties.

  • Webinar: CPT Code G2211 for ID Physicians link

    Dr. Timothy Sullivan, vice chair of IDSA’s Coding & Payment Subcommittee, and Dr. John Fangman, member of both HIVMA's and IDSA’s Coding & Payment Subcommittee, discuss the new G2211 code introduced in the 2024 evaluation and management services revisions by the Centers for Medicare & Medicaid Services. In this 10-minute informational video, they discuss how this code can be used by ID clinicians with real-world examples.

Evaluation and Management Services

  • 2024 EM Services Reference Guide pdf

    This E/M guide was created by ID physicians to explain the 2024 AMA CPT rules and provide examples of how they can be used in ID.

  • Split/Shared Resources Infographic pdf

    Infographic: Physician and Physician Assistant or Nurse Practitioner Work Together to Perform the Evaluation and Management Service

  • CMS E/M Guide pdf

    2024 E/M Guide from CMS to explain the new coding rules.

  • Revisions to the CPT E/M Office Visits: New Ways to Report Using Time link

    Substantive revisions were made to the CPT codes related to office and other outpatient services, collectively known as the evaluation and management codes. This second module, in a series of three, will provide detailed information on how the revisions to the CPT E/M office visits will affect time.

  • CPT® Evaluation and Management link

    Summaries of revisions to the E/M code descriptors and guidelines from AMA throughout the last six years. On Nov. 1, 2019, the Centers for Medicare and Medicaid Services finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule. This provision includes revisions to the evaluation and management office visit CPT codes (99201-99215) code descriptors and documentation standards that directly address the continuing problem of administrative burden for physicians in nearly every specialty, from across the country.

  • Webinar: Learn from the ID Experts: Navigating the Revised CPT® Codes for Office and Outpatient E/M Services link

    January, 2021. Revised CPT codes and associated documentation for office/outpatient evaluation and management services. Dr. Ronald Devine and Dr. Prashant Malhotra, IDSA members and CPT code experts, explain the revisions and how to navigate the changes. This webinar was created specifically for ID physicians.

FAQs

Billing and coding FAQs

IDSA’s Coding and Payment Subcommittee has developed FAQs about billing and coding to help ID physicians and their staff.

Accurate coding and billing can result in more appropriate and timely reimbursement, while also protecting against claims denials and audits. Understanding coding and billing is an essential component of advancing ID physician compensation.  

“QHCP” is a qualified health care professional, defined by the American Medical Association as “an individual who is qualified by education, training, licensure/ regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional service.” 

“NPP” is used by Medicare and other payers to describe a non-physician practitioner, such as a physician assistant and nurse practitioner. 

No. Split or shared visits are visits in the outpatient setting that are shared between a physician and NPP within the same group practice. This means that both a physician and an NPP have face-to-face contact with the patient during the same visit. “Incident to” services are those that are furnished as an integral, although incidental, part of a physician’s professional service in the course of diagnosis or treatment of an injury or illness. These services must be performed in a non-hospital setting and under the direct supervision of a physician. The services are typically performed by NPPs.

Level of service selection is based on medical decision making or time, but it is important to document an appropriate history and physical examination, when performed, as this documentation can also support the level of service selected. It is also important to appropriately document the patient encounter, including history and physical examination, when performed, to convey information and plan of care in the medical record to other clinicians. 

 

A patient is considered “new” to the provider if that patient has not received any professional service from that provider or any other provider in the same group within the previous three years. 

When a physician or QHCP is covering for another physician/ QHCP, then the encounter would be billed as if the unavailable provider is doing the encounter (i.e., it would not count as a new patient or visit).

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