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Coding for a Hospice patient

  1. Smile Coding for a Hospice patient
    Medical Coding Books
    Hi Friends,

    Hope you help me with this !

    We have billed CPT 99214 for a patient of a pain-management provider. Medicare denied the claim saying Patient is enrolled in Hospice.
    Should we append any modifier to CPT 99214 to get paid for it.
    In case of Nursing home visits we have used GW modifier & got paid for it.
    What should we do ?

    Thanks & Regards
    Neha Bhatnagar CPC, CPC-H

  2. Default
    You are correct the Modifier GW will pass the Medicare edits and they will pay. When hospice signs a patient to their care it is with a certain diagnosis. The service you render if it is not related to the diagnosis that hospice has Medicare will pay for the service with the modifier.

    Stephanie Calley CPC-H

  3. Default
    I work for an internal medicine practice and this happens to us all the time we have to use the gv modifier which is attending physician not hospice employee. All of ours go through with no issue. Hope this helps

  4. #4
    North Carolina
    GV modifier= Used when a physician is the attending physician for a hospice patient and not associated with the hospice in any way but who is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice.

    GW modifier= Used when a physician is the attending physician for a hospice patient and not associated with the hospice in any way and providing a service that is not related to the diagnosis for which a patient has been enrolled into hospice.

    The modifier will be determined by the reason for the visit....Since this is a Pain Mgmt provider, it's not clear to me since we don't know the reason for the visit. It seems obvious but I tend not to assume.
    Rebecca CPC, CPMA, CEMC

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  5. Default Billing for hospice patients
    My provider visits nursing homes and sometimes see's patient that are covered by Hospice. She is coding nursing home E&M's and using the GW or GV modifier. Most of these visits go unpaid, the denial reason given by Medicare is incorrect insurance package was chosen. She can't bill under Medicare A as she isn't the facility or an employee of the facility. So we bill under Medicare B and I'm thinking the denials are because she isn't the patients chosen provider at the time that the patient entered into hospice. Does anyone have any further information or experience with this?

  6. Default Hospice billing help needed
    I work for a hospice company. We seem to be having an issue with the way we are reporting the physician visits.

    For example: patient is admitted on services on 01/01/2017. Patient received core services, billed as RHC routine home care (revenue cide 651) for DOS:01/01-01/04. On 01/05 physician (who works under our group/billing NPI because he is employed by hospice company) visits patient and therefore reports and evaluation and management code. Should this be an initial visit or a subsequent visit?

    01/05 is truly the first time the physician sees the patient. 01/01-01/04 patient was not seen by physician, rather a nurse and that is why we report 651 for the day providing hospice care (nurse visits, anything to make them comfortable)

    When billing a commercial carrier, in which we are contacted to receive seperate reimbursement for physician visits, we are reporting initial visit and DOS remains denied because carrier is stating patient was established as of 01/01...

    Can you please shed some light as I have tried to wrap my brain around it and cannot. We have people here insists it should be an initial but carriers across the board denial raise questions. Should we fight this decision or are they correct in denying?

    Could we be reported Incorrectly? We are billing both service on same claim with the companies group NPI and TAX ID combo as the physician is contacted by the group. And the physician code is being submitted with revenue code 657 and the appripate CPT in accordance with complexity.

    Please help!

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