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Caralee Posted Tue 29th of August, 2017 16:21:44 PM
The pt. was originally admitted to hospital. Our provider saw pt. in hospital. After discharge from the hospital, pt. was admitted to Rehab facility as inpatient. While pt. was inpatient at rehab facility, pt. came for an office visit with our Dr. Medicare denied our claim for office visit stating that " Medicare does not cover outpatient visit while pt. was inpatient at different facility. Please give the guidance for any modifier or different way to bill Medicare so that office visit can be paid to provider. Thank you.
SuperCoder Answered Wed 30th of August, 2017 02:03:55 AM

Hi Caralee,

Below are some of the modifiers that need to be appended. However, as per your medical records you need to check which suits your documentation.

GV Modifier
The GV modifier is used when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.

GW Modifier
The GW modifier is used when a physician is providing a service that is not related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice and is providing services as a private physician.

When a patient is under hospice there is a certain diagnosis that was indicated at the beginning of care. 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.

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