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Critical Care Coding with proper Modifier when billing 36558 along

Armando Posted Wed 09th of November, 2016 17:01:34 PM
Hello, we have a Pulmonary Critical Care specialist we are billing for. We bill out code 99291 using modifier GW,25 along with cpt code 36558 GW our dx is J18.9, A41.9 will this get paid by Medicare FL ?
SuperCoder Answered Thu 10th of November, 2016 02:01:27 AM

Medicare guidelines says if the reason for the encounter is not related to the terminal illness, then the physician office would append modifier GW - service not related to the hospice patient's terminal condition" to the service. If the patient is in the hospice for the condition unrelated to the current problem, then appending modifier GW is correct. 

Note: The diagnosis code of your current problem should differ from the terminal illness diagnosis code (from which patient is suffering) to suggest the problem is different from terminal illness.

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