Internal Medicine Coding Alert
Internist Sees Hospice Patient
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Question: I am overseeing care for a patient receiving hospice care. Are there rules about billing E/M codes with hospice patients? Is there a modifier one uses to get paid? I remember reading that physician services are considered bundled into the hospice charges for the medical director who sometimes manages these patients. Michigan Subscriber Answer: Yes, you will need to use a modifier to be paid for your services in the scenario you describe. When a patient elects to have hospice services, he may designate that he wishes to receive care from an attending physician not employed by the hospice in addition to receiving care from hospice-employed physicians, according to Section 4175 of the Medicare Carriers Manual (MCM). When the attending physician who is not employed by the hospice sees the patient for care related to his terminal condition, she should bill using the appropriate E/M code appended with modifier -GV (Attending physician not employed or paid under arrangement by the patient's hospice provider). If the physician provides services that are not related to the hospice patient's terminal condition, the physician should instead use modifier -GW (Service not related to the hospice patient's terminal condition). If your physician was affiliated with the hospice, the payment scenario would be different. When a designated physician has a payment arrangement with the hospice to provide services to patients, then the hospice, not the physician, bills the appropriate fiscal intermediary for these services. Answers to You Be the Coder and Reader Questions were provided by Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.
If the patient exhausts his hospice benefits but remains under hospice care, you may still bill covered, medically necessary services to Medicare, but you should no longer use modifiers -GV or -GW, according to the MCM.
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