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Hospice Patients

  1. #1
    Default Hospice Patients
    Medical Coding Books
    Are there any coding guidelines to follow for coding E/M visits to patient's who are in hospice? We have a hospice patient coming into see an ortho in his office.

    Thanks
    Jess

  2. #2
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    ENGLEWOOD/DENVER
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    Interesting that you asked that question, I had the same scenario this morning. Hospice patient came to see our ortho guy, we billed to MCR Part B, claim was denied. It was brought to me to figure out. I went to the MCR website and pulled information that states that once the patient has signed up for hospice, they no longer have access to Part B benefits. The claim is billed through hospice in the same manner that we have to bill SNF for radiology.

    hope this helps
    Mary Bort, CPC

  3. #3
    Default
    There are some scenarios where you can bill Part B. I would think that in both of your scenarios you could but you have to use modifier GV - attending physician not hospice or GW- service unrelated to terminal condition. If you are seeing the patient in an office setting I would try submitting it again to Medicare and using the GW modifier then if that doesn't work bill Hospice.
    Hope this helps!
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  4. #4
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    ENGLEWOOD/DENVER
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    thanks Susie!! I'll give that a shot!

  5. #5
    Location
    North Carolina
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    This may be helpful information. Take a look at section 4175.




    http://www.cms.hhs.gov/transmittals/...ds/R1728B3.pdf

    Rebecca

  6. #6
    Location
    Augusta chapter
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    17
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    The visit should be unrelated to the reason for the hospice-use modifier GW, icd-9 for hospice care is V66.7-this is related to reason for hospice.

  7. Default
    This is what a hospice center sent me:

    "All services provided to a Hospice Patient that are NOT related to the patient's terminal diagnosis are billed by the provider of the services directly to the patient's insurance. In the case of Medicare patients 'If the issue is not related to the terminal diagnosis, then the physician will bill through Part B. There is a new process in which the phyiscian indicates via a GW modifier in the box24d of the billing form that the service is not related to the terminal diagnosis.

    All services and procedures not related to a patient's terminal diagnosis are not covered under the patient's hospice benefit.

    All services and procedures related to a patient's terminal diagnosis are covered under the patient's hospice benefit and all bills should include GV modifier code in box 24d (GV:Attending Physician not employed or paid under arrangement by the patient's hospice provider). Primary Physicians can bill Medicare directly for one (1) administrative service to Medicare Part B in a calendar month."

    Sorry so long, I wanted to quote the entire letter the hospice sent me.

  8. Default
    I am a newbie, but worked at Medicare for 16 years and now a coder, and the correct way to bill is with the GW modifier for a non-hospice provider. Medicare has on file the start and end dates for Hospice and if your DOS falls within those dates without the GW modifer, it will deny.

    It is very important that when a patient is referred to another physician that they give share the Hospice information

  9. #9
    Default I am a newbie to Hospice Billing also
    I have a question, I work in Hospice and Palliative Care for the last couple of months and see that for Nurse Practioners, they put the GV or GW modifiers on the bills, but the patient is either in full hospice or we see the patient in their home. Does a GV or GW modifer need to be still used in that case?

    Elizabeth

  10. Default
    For the hospice, a modifier would not need to be used.
    The modifiers are for physician/nurse practioners to use depending on related or non related ... per notes above in this thread.


    Quote Originally Posted by encomma-watson View Post
    I have a question, I work in Hospice and Palliative Care for the last couple of months and see that for Nurse Practioners, they put the GV or GW modifiers on the bills, but the patient is either in full hospice or we see the patient in their home. Does a GV or GW modifer need to be still used in that case?

    Elizabeth

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