Gastroenterology Coding Alert

Question: We recently received a denial from Medicare for a patient in hospice care. Can we bill the hospice for the services provided by our gastroenterologist or should we try the insurance payer to pay for the services rendered?

Michigan Subscriber

Answer: The hospice is not liable to pay for the services rendered by your gastroenterologist to the patient. The hospice could have been billed for the services rendered by your gastroenterologist if there was a prior arrangement between the hospice and your gastroenterologist for the services rendered to the patient. Your gastroenterologist would have been eligible for payment from the hospice if he was a consulting gastroenterologist for the hospice or was employed by the hospice to render the services in question to the patient.

However since there is no such prior arrangements between the hospice provider and your gastroenterologist, it is best to again try to re-bill the insurance payer. You will need to append one of these suitable modifiers to the CPT® codes that you have used to bill initially for the services rendered by your gastroenterologist.

You have to append the modifier GV (Attending physician not employed or paid under arrangement by the patient's hospice provider) or GW (Service not related to the hospice patient's terminal condition) to let the insurance payer know that the hospice is not reimbursing your gastroenterologist in any manner for the services rendered. This will also inform the payer that the hospice is not eligible to bill for the services rendered by your gastroenterologist.