Oncology & Hematology Coding Alert

Question: When is it correct to use modifier GV?

Iowa Subscriber

Answer: You should append modifier GV (Attending physician not employed or paid under agreement by the patient's hospice provider) to Part B claims for your oncologist's hospice services if the physician and service meet certain conditions:

1. Independent attending physician: To use modifier GV, the hospice patient must have designated the oncologist as an independent attending physician, which means the hospice does not employ or have a payment arrangement with the oncologist. Tip: The term "independent attending physician" may apply to a nurse practitioner.

2. Related to terminal illness: Before appending GV, be sure the oncologist saw the patient to treat or manage the terminal illness. For services related to other diagnoses, consider modifier GW (Service not related to the hospice patient's terminal illness).

3. Professional services: If the oncologist provides a service with both professional and technical components, you should submit a Part B claim with modifier GV for the professional component only. Look to the hospice for technical component payment. If the service has no professional component, you again will have to work with the hospice for payment. You should not submit claims for those services to your Medicare carrier or contractor.

Remember that for this rule to apply, the patient must have indicated to Medicare at the time of hospice election that the oncologist is the independent attending physician "having the most significant role in the determination and delivery of their medical care" (Medicare Claims Processing Manual, Chapter 11, Section 40.1.3).

Watch for: The manual further states, "Hospices should reiterate with patients that they must not see independent physicians for care related to their terminal illness other than their independent attending physician unless the hospice arranges it."

If your oncologist is not a designated attending physician (or substituting for one), you will have to coordinate with the hospice for payment.

Learn more: You can read more about hospice claims and independent attending physicians in the Medicare Claims Processing Manual, Chapter 11, Section 40.1.3, available online at  www.cms.hhs.gov/Manuals/IOM/list.asp.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Los Angeles-based Sinaiko Healthcare Consulting Inc.