In simple words: This code is used for patients between 66 and 80 years old who have experienced frailty and have been diagnosed with a serious illness.

This code identifies a patient between 66 and 80 years old with at least one claim or encounter for frailty during the measurement period and either one acute inpatient encounter with an advanced illness diagnosis or two outpatient, observation, emergency department, or non-acute inpatient encounters with an advanced illness diagnosis on different dates of service during the measurement period or the year prior. Frailty refers to the physiologic decline associated with aging. This code is used for quality measure reporting.

Example 1: A 72-year-old patient with documented frailty is admitted as an inpatient with a diagnosis of advanced heart failure. Code G2126 is used for quality reporting related to frailty and advanced illness., A 68-year-old patient with a history of frailty presents to the emergency department twice in the measurement period, once for a COPD exacerbation and again for a urinary tract infection. Because the patient has two outpatient encounters with diagnoses that could indicate advanced illness, G2126 is reported. , An 80-year-old patient with a documented episode of frailty during the measurement period had an acute inpatient encounter for pneumonia in the year prior to the measurement period. G2126 is reported.

Documentation should include the patient's age, evidence of frailty during the measurement period, and the diagnosis of advanced illness with the date and setting of the encounter(s).

** Some G codes represent procedures and services that would otherwise be coded with CPT codes but lack a CPT equivalent. Other G codes are used for quality program measures. Refer to specific program guidelines for complete submission requirements and procedures.