Endocrinology, coded right.

99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time.

Use 99215 when the encounter genuinely required high-complexity decision-making: severe exacerbation or decompensation of a chronic illness, an acute or chronic illness or injury that poses a threat to life or bodily function, decision regarding hospitalization, drug therapy requiring intensive monitoring for toxicity, or extensive comorbidity management driving a high-risk decision. Real examples: a CHF patient with new bilateral leg edema and dyspnea where you considered emergency admission; a new-onset AFib with RVR you elected to manage outpatient with same-day rate-control titration; an oncology patient with febrile neutropenia. Time-based alternative is 40 to 54 minutes of total time on the date of the encounter.

G2211 is the continuity add-on. Append it to an office E/M (99202 through 99215) under one of two conditions: you are the continuing focal point for all of the patient's health care (the primary-care framing), OR you are the ongoing care provider for a patient's single serious condition or a complex condition (the subspecialty framing). Common eligible scenarios: a routine primary care follow-up for chronic disease management; an endocrinology continuity visit for diabetes; an oncology survivorship visit; a rheumatology disease-modifying-medication monitoring visit; a nephrology follow-up for CKD progression. Ineligible scenarios: one-time consults, urgent care visits, hospital follow-up where you are not the longitudinal provider, and visits where modifier 25 is appended to the primary E/M (explicitly prohibited).

One-time CGM setup and training when patient owns the device. Once per device, not once per visit.

Practice-supplied CGM (you own the device and loan it for a sample period). Once per 30 days.

CGM data review and interpretation. Once per 30 days regardless of who supplied the device.

Use 76536 for thyroid ultrasound (the most common indication) or imaging of other soft-tissue structures in the head and neck (salivary glands, parotid mass, cervical lymphadenopathy, parathyroid localization). Standard thyroid indications: thyroid nodule evaluation, monitoring known nodules per TIRADS or ATA guidelines, TSH abnormality workup with palpable thyroid abnormality, follow-up post-thyroidectomy or radioiodine ablation. Often paired with 76942 (US guidance for needle placement) when biopsy is performed.

Percutaneous needle biopsy of the thyroid.

Use G0270 when a Medicare beneficiary needs MNT beyond the annual benefit window because their clinical condition, diagnosis, or treatment plan has changed. Common scenarios: a T2DM patient with new diagnosis of CKD requiring renal-specific MNT, a CKD patient initiating dialysis, a newly diagnosed diabetic after the routine MNT annual hours have been used, a post-bariatric-surgery patient with new nutritional needs. The Medicare annual MNT benefit covers 3 hours of MNT in the first year and 2 hours annually thereafter (97802 and 97803). Once those hours are used, G0270 covers additional MNT triggered by clinical change.

Use G0447 for Medicare-covered intensive behavioral therapy for obesity in a primary-care setting. Eligibility requires BMI 30 or greater documented on or near the date of service. The CMS-defined cadence is weekly for the first month, biweekly for months 2 to 6, then monthly for months 7 to 12 if the patient has lost at least 6.6 pounds during the first 6 months ("6.6-pound rule"). Total session cap: 22 sessions per 12-month period. The 5-A framework (Assess, Advise, Agree, Assist, Arrange) provides the documentation backbone. The 12-month period restarts when the patient achieves a 5-percent weight loss from baseline.