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Patient enrolled in a Hospice - Medicare Denial

  1. Default Patient enrolled in a Hospice - Medicare Denial
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    I need advice to a denial from Medicare today.
    I have a patient that is in a facility (designated as a Assisted Living Facility) but a hospice bed.
    I have billed this with a POS 13 (ALiving) with CPT code 99335. It has been denied due to "Patient enrolled in a Hospice". Any advice; I just can't seem to get this paid!

    Thank you in advance

    Charisse

  2. #2
    Location
    Columbia, MO
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    12,560
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    you probably need one of the hospice modifiers, one is gw and I forget the other one.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    North Carolina
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    3,126
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    You would report the GW modifier (service not related to the hospice patient's terminal condition) if the service was unrelated to the hospice condition.

    The other is GV-

    http://www.cms.gov/manuals/downloads/clm104c11.pdf

    Section 50
    Last edited by RebeccaWoodward*; 08-02-2010 at 10:32 AM. Reason: link provided

  4. Default Modifier on Hospice Claim
    That is it! I am closing in on these claims; I had forgotten my GV or GW modifiers.

    Thanks so much!

    Charisse

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