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Hospice Modifier GW

  1. #1
    Unhappy Hospice Modifier GW
    Medical Coding Books
    I'm in desperate need of documentation that supports the answer to this question:

    Can the GW modifier be appended to physician visits unrelated to the hospice condition even though he is employed by or in agreement with Hospice?

    WPS is our Medicare carrier and the site specifically states:
    Medicare Part B can reimburse for the attending physician services ONLY when there is NO employment or arrangement between the attending physician and the hospice. Please note: Medicare considers a physician volunteering with the hospice to be an employee.

    However, the modifier fact sheet for GW (services unrelated to the terminal condition) doesn't specify that this can NOT be used by the attending physician employed or in agreement with Hospice.

    I feel it's very black and white in the first paragraph-there is no exception. However, without something stating the employed physician can't use GW, I'm stuck with a physician who believes he should be able to bill Medicare Part B.

  2. Default GW
    The services of the attending physician are billed to Medicare Part B with the GV modifier - Attending physician not employed or paid under agreement by the patient's hospice provider as long as the provider does not have a payment arrangement with the hospice. If there is, then the hospice includes the attending physician services in their services billed to Medicare Part A.

    I would assume since the provider is employed or contracted with hospice he or she would not be eligible to bill part B, as it is included in the services billed to part A whether it is or is not related to hospice.

  3. #3
    Default
    Thank you so much for the reply! That was my interpretation as well, but I needed to have that verification.

  4. #4
    Default reply
    Quote Originally Posted by AR2728 View Post
    I'm in desperate need of documentation that supports the answer to this question:

    Can the GW modifier be appended to physician visits unrelated to the hospice condition even though he is employed by or in agreement with Hospice?

    WPS is our Medicare carrier and the site specifically states:
    Medicare Part B can reimburse for the attending physician services ONLY when there is NO employment or arrangement between the attending physician and the hospice. Please note: Medicare considers a physician volunteering with the hospice to be an employee.

    However, the modifier fact sheet for GW (services unrelated to the terminal condition) doesn't specify that this can NOT be used by the attending physician employed or in agreement with Hospice.

    I feel it's very black and white in the first paragraph-there is no exception. However, without something stating the employed physician can't use GW, I'm stuck with a physician who believes he should be able to bill Medicare Part B.
    I agree with Tiffany reply it can be a bit tricky but I use GV if the Dx is related to why the pt is in hospice.

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