Carmen Posted Wed 28th of December, 2011 17:31:42 PM
What is the proper way to bill when a hospice patient presents to the physician's office for treatment for a medical conditiion other than the terminal diagnosis?
(Example: patient with esophageal cancer seen for hospital follow up for emphysema)?
SuperCoder Answered Wed 28th of December, 2011 19:18:59 PM
If the service the physician renders is unrelated to the terminal illnesses that hospice has on record, Medicare will not reimburse for the service unless it is submitted with the modifier GW. The GW modifier cuts through the Medicare edits and will pay.
Sandie Answered Wed 28th of December, 2011 20:13:43 PM
What is the difference between the GV and the GW modifier for medicare?
SuperCoder Answered Wed 28th of December, 2011 20:48:27 PM
The details can be referred in:
This modifier must be submitted when a service meets the following conditions, regardless of the type of provider:
--The service was rendered to a patient enrolled in a hospice.
--The service was provided by a physician or non-physician practitioner identified as the patient’s attending physician at the time of that patient’s enrollment in the hospice programphysician at the time of that patient’s enrollment in the hospice program.
Do not submit the GV modifier in the following conditions:
--The service was provided by a physician employed by the hospice.
--The service was provided by a physician not employed by the hospice and the physician was not identified by the beneficiary as his attending physician.
This modifier should be used when a service is rendered to a patient enrolled in a hospice, and the service is unrelated to the patient’s terminal condition. All providers must submit this modifier when this condition applies or when claims are submitted for treatment for a non-terminal condition.