# Hospice billing - physician is providing a service



## knperry (Jan 15, 2013)

I need help with using the hospice modifiers.  This is the situation, we had a patient that was admitted to the hospital on 4/14/12 and he expired on 5/3.  After receiving the EOB for what I billed medicare paid service dates 4/14, 4/16-4/26 & 5/1.  The other dates were denied due to patient enrolled in hospice.  Now, I called medicare and the rep said that there was an open window for hospice and that the claim would need a modifier (was surprise she told me tht).  I then called the pt's wife to verify how many days he was in hospice she said 5/2-5/3.  After speaking with her I researched and found out that modifier GV is used when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice.  GW is used when a physician is providing a service that is not related to the diagnosis for which a patient has been enrolled into hospice.  I'm going to double check with the doctor but I think I would use GV because the patient was in a car accident the day he was admitted to the hospital with serial complications and during his stay (according to his wife) he ending up in hospice for 1 day and passed.  My questions are why would medicare pay the first day deny the next day then pay the next serial days then deny the next two days pay the next day then deny the last two days!  My second question is how would I fill out the cms form.  The patient was in the ICU code 99291, do I attach the modifier GV to the 99291?  Do I put the code on each line that was denied?  Any guidance would greatly be appreciated.


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## Deana Banks (Jan 23, 2013)

Hello, yes you should be using a GV mod. " physician is not employed or paid under agreement by patients hospice provider". I am not sure why they are paying some claims and denying the others. If Medicare pulls their money back rebill with GV mod.  You will put these Modifiers on the line with your CPT/HCPCS codes.  For the future keep in mind Medicare replacement  products will kick hospice patients back to straight medicare once they are on hospice care. Good luck.
Deana B.
Medical billing specialist


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