Wiki Pacemaker or ICD checks and Hospice

dls

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Can anyone help me? We do device checks in office and remote. So we have had patients on hospice who still get their devices check and see Doctor and I use the GW modifier because I was told by the patients family they are not on hopsice for his heart conditions. I never had a problem with this kind of thing. My problem is when do I know the specifics of a patients hospice and what our role is? I have patients that come in and are on hospice and we dont know because the family says nothing and I get denials, how do I know if that patient should still be seen or still have their deviced checked? Do I call the PCP or family or nursing home if they are in one. I dont want to bill with the modifier if they should not be seen.
 
You would need to find out primary hospice diagnosis. When patient elects hospice, a PCP or attending phys. is required to attest to terminal illness (life expectancy of 6 months or less). This is documented on NOE or notice of election form. If the pacemaker check is not due same diagnosis patient elected hospice, you can bill and be reimbursed for services by using modifier GW and normally would need to justify medical necessity.

i.e. patient on hospice for alzhemiers or dementia but still needs to check in doctors for diabetes and high blood pressure since Hospice is non-curative.

hope this helps!
 
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