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Thread: Hospice Question

  1. #1
    Join Date
    Apr 2007

    Question Hospice Question

    AAPC: Back to School
    I do not have any experience billing for a patient that is under Hospice so I am hoping someone will be able to shed some light on my dilemma.

    I have a patient that is enrolled in hospice. This patient has pancreatic cancer. He was seen by my MD, who specializes in Pain management, for an inpatient consultation. Our MD also had subsequent hospital care days and did perform a celiac plexus block during the hospital stay. Medicare has paid on every charge other than the intial inpatient consult. Is this payable by Medicare?

    Missy Heuer CPC, CANPC

  2. #2
    Join Date
    Apr 2007


    Diagnosis and attending physician are key when billing Medicare for patient enrolled in Hospice. If your Medicare B carrier is Noridian, then the following information is from Medicare B News Issue 232 October 31, 2006:

    If the beneficiary is seen by any physician other than his/her primary attending physcian for a "hospice diagnosis," submit the charge to Hospice.

    If the beneficiary is seen by a physcian other than his/her primary attending physician for any diagnosis other than the hospice diagnosis, submit the claim to Medicare Part B.

    If the beneficiary is seen by his/her primary attending physician for any diagnosis, including the hospice diagnosis, the claim should be sumitted to Medicare Part B.

    You need to contact your hospice for confirmation of the "hospice diagnosis" and the patient's attending physician.

    You need modifier GW when services are not related to hospice patient's terminal condition and GV when billing for the attending physician for the terminal condition, unless employed or paid by Hospice (see HCPCS book under modifiers).

    Kay Ruhe, CPC, CCS-P

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