AI Scribe for Cardiology: Capture G2211 on HF Visits

Why G2211 Lives or Dies in the Assessment

Every heart failure follow-up carries a quiet question for the auditor. Is this cardiologist the continuing focal point for a single, serious condition, or simply the clinician who happened to see the patient today? HCPCS G2211 pays for the former. CMS describes the code as reflecting the inherent complexity of ongoing care. Medicare contractors look for four things: medical necessity, a longitudinal plan, evidence of the focal-point relationship, and cognitive effort that reaches beyond an episodic visit.

Most cardiology notes already contain that evidence, but it is scattered across echo reports, device interrogations, and medication histories. It rarely appears where reviewers read first. Merry AI was built around one observation from clinic: the Assessment and Plan is where complexity must be stated plainly, in the clinician's own reviewed words, with numbers attached.

Stating the Single Serious Condition

A defensible Assessment names the condition, its phenotype, its stage, and its trajectory in one sentence. For example: Chronic HFrEF, Stage C, under my ongoing management; LVEF 30% (June 2023), 35% (March 2024), 42% (September 2026); NYHA class III improved to class II on ARNI, beta-blocker, MRA, and SGLT2 inhibitor at maximally tolerated doses. That single line establishes the serious condition, the longitudinal relationship, and the titration work that justifies the add-on. Merry AI drafts this sentence from the encounter and prior data. The cardiologist confirms or edits it before signing.

The Longitudinal Heart Failure Record

Heart failure documentation follows a grammar most cardiologists learned in fellowship. It includes the LVEF phenotype (HFrEF at 40% or below, HFmrEF at 41 to 49%, HFpEF at 50% or above), ACC/AHA stage A through D, NYHA functional class I through IV, and the four pillars of guideline-directed medical therapy. The engine maps each visit to these elements so the trend is visible rather than inferred.

Diagnosis coding should match the narrative. Chronic systolic, chronic diastolic, and chronic combined heart failure carry distinct ICD-10-CM codes (I50.22, I50.32, I50.42). The official code sets are maintained at https://www.cms.gov/medicare/coding-billing/icd-10-codes. If the phenotype in the Assessment and the code on the claim disagree, the G2211 argument weakens, however complete the rest of the note may be.

LVEF and NYHA as a Trend Line

The engine pulls prior LVEF percentages and NYHA classes from echo interpretations and earlier heart failure clinic notes, then presents them as a dated series inside the draft. A patient whose ejection fraction recovered from 25% to 45% over three years is managed differently from one whose ejection fraction declined from 50% to 38%. Both stories support G2211, but only if the trajectory is written down. When a value is missing or ambiguous, the draft flags it for the clinician rather than guessing.

Writing Into the Assessment and Plan

Ambient capture is only useful if the note lands in the right place. Merry AI runs as a Chrome Extension inside the clinician's existing EHR session, so no interface engine or API contract is required. After review, the structured Assessment and Plan is delivered directly into the cardiology progress note, alongside the HPI, interval history, and device findings.

Selector Targeting and Fallbacks

Each supported note layout is mapped to specific Assessment and Plan textarea selectors, as well as to the contenteditable rich-text editors that many browser-based EHRs use. On insertion, the extension sets the field value and triggers the input and change events the EHR expects, so the chart registers the edit as the clinician's own. Each draft is tied to the active patient and encounter, which prevents it from landing in the wrong chart when a cardiologist switches tabs between visits. If a cross-origin iframe or strict content security policy blocks insertion, the note is copied to the clipboard for a single paste, and the clinician is told why.

Coding Guardrails and Audio Handling

G2211 is an add-on, not a standalone claim. It attaches to office or outpatient E/M codes 99202 to 99205 and 99211 to 99215. Beginning in 2026, it also attaches to home or residence visits 99341, 99342, 99344, 99345, and 99347 to 99350. When the E/M carries modifier 25, G2211 is payable only if the same-day service is an annual wellness visit, vaccine administration, or a qualifying Part B preventive service. Merry AI surfaces these conditions as prompts. It does not code on the clinician's behalf.

Audio is held in memory only while it is transcribed and is then discarded. No recording is written to disk or kept after the session. The resulting text is still protected health information, so it is governed under a signed Business Associate Agreement, with encryption in transit and at rest. Clinicians who want a starting point can review the cardiology prompt packs at https://templates.scribing.io. These include heart failure follow-up, atrial fibrillation rate control, and post-PCI templates.

The aim is modest and durable. Every note should read the way a careful cardiologist would write it with time to spare, and every Assessment should answer the auditor's question before it is asked.