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medicare and hospice modifier

  1. Question medicare and hospice modifier
    Clearnace Sale
    I am in dermatology and have never dealt with a "hospice patient" but just received a denial of paymnt from medicare with a response of pr-b9-stating that this is pt responsibility- services are not covered because the patient is enrolled in a hospice...I remember one time seeing a similar case when medicare did pay on a claim similar to this-there was a specific modifier applied-any ideas? the claim for this date of service is 99202,11100 and 11101.
    thank you

  2. #2

    I believe the modifier you're talking about is GV. Also, in Box 19 of your claim form you must include wording that states "physician is not hospice employee".

    Hope this helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    Wheeling WV
    Also GW modifier may apply (service not related to terminal condition)..

    Hope this helps..

  4. #4
    GV & GW are the hospice modifiers. Just make sure that you meet the criteria for the modifier. (IE - Being the attending physician) Also, unless certain contractors require it, it isn't necessary to put anything about the physician not being employed by hospice in item 19; the modifier will suffice.
    Amy Crego, CPC, CPC-P, CPMA, CRC
    Vice President, Columbus, OH AAPC

    One can never consent to creep when one feels an impulse to soar. ~ Helen Keller

  5. Default
    Professional services of attending physicians, who may be nurse practitioners, furnished to hospice beneficiaries are coded with modifier GV. (Attending physician not employed or paid under arrangement by the patient's hospice provider); the GW modifier is billed for services unrelated to the terminal illness
    CMS Pub 100-4, Chap 11 Section 40.2; or CR 3226

  6. Default
    When using a modifier GW or GV where should it be applied to when a modifier 25 is also being used?

  7. Default modifier for hospice
    You should be able to append 2 modifiers to one line item.

    The modifier affecting "payment" is always listed, in this case...the modifier 25 would be first, since it affects the "amount" of payment and the GV modifier is more informational, letting Medicare know that your physician is not an employee of hospice...but this care occured during the time that the patient was actually enrolled in hospice.

    a good/better example of using 2 modifiers would be when you are performing only the technical or professional component of an x-ray.

    The TC or the 26 modifier affects payment (reduces it)...and the LT or RT is identifying left or the TC or 26 would go first.

  8. Default cpt 99308
    different question to this thread if anyone has an answer: we billed 99308-subsequent nursing facility care and medicare denied patient is on hospice. Can we add modifier GV or GW to this code?

  9. #9
    Yes, you can add hospice modifiers to nursing facility codes.

    Dermatologists will generally use GW, not GV, because what we are not treating the terminal condition.

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