Results 1 to 6 of 6

Flu Vaccine and Hospice

  1. #1
    Louisville Kentucky Chapter
    Question Flu Vaccine and Hospice
    Medical Coding Books
    I'm really hoping someone can help me. My physician gave one of her Hospice patients the Flu Vaccine. The patient is on Medicare. I submitted the CPT codes of 90656 and G0008, but they denied this with the reason being "Patient is enrolled in a Hospice."
    Will they really not cover the flu vaccine for someone on Hospice or do I just need to resubmit this using the -GW modifier (Service not related to the hospice patient's terminal condition)? It doesn't say anything about a missing modifier, but I'm thinking this might be the problem.

    Thanks for your help ahead of time.

  2. #2
    Charleston, South Carolina
    I would check with the Hospice as to who you should bill. Usually when enrolled in Hospice, you bill Hospice. They will be able to tell you if you should bill them or Medicare with the modifier. Its been a while since I have done this to be more help. I am sure Hospice can direct you.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  3. #3
    Louisville Kentucky Chapter
    Thanks Machelle. I'll give that a try then.

  4. #4
    Default flu for hospice
    Quote Originally Posted by JeannieG View Post
    Thanks Machelle. I'll give that a try then.

    did you ever receive an answer for this; i had the same thing happen- resub w the gw and was denied again as provider should not bill for service or be given by that "specialty" we are internal med... do i use gv instead?

  5. Default
    I work at a SNF and when I bill for a flu Vaccine I have to put a 07 condition code.

  6. Default
    If the Dx is unrelated to the hopice admit Dx you append Modifier GW. Any time patient is in hospice, call MC to see what hospice facility they are in & the dates they are enrolled in hospice then call that hospice facility to find out who admitting Dr is & the Dx they were admitted under. This information decides whether you use a GV modifier or GW modifier.

Similar Threads

  1. Flu Vaccine
    By tmr1965 in forum Family Practice
    Replies: 11
    Last Post: 10-15-2015, 02:50 PM
  2. Flu vaccine
    By PennyG in forum Pediatrics
    Replies: 1
    Last Post: 11-04-2009, 01:37 PM
  3. flu vaccine
    By safnlp in forum E/M
    Replies: 5
    Last Post: 10-23-2008, 09:14 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.