Wiki Hospice Care Pt seen in outpt dr office

[aksockmonkey@gmail.com]

I have a pt who is currently residing in an extended care home. She had to be brought to our office for a particular procedure to be done as the staff at the home were unable to complete the procedure. Because we are billing it from an outpatient setting but the patient is technically inpatient Medicare is denying our claim. In the past when we have had this situation we have sent the bill to the extended care facility and they have paid it. However, in this case the facility is stating there is a modifier that needs to be put on the codes. Does anyone know what modifier this might be? The only thing I have found that I think she might be referring to is "GV". HELP! Thanks.

 

[MoonSad137]

GV vs GW modifiers

I think you have two options, GV and GW

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.

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.

At least that is my understanding of these modifiers.