Gastroenterology Coding Alert

Question: My gastroenterologist performed a home visit on a patient under hospice care (in addition to the hospice MD). We're receiving denials stating we should be using modifier GV, so we used this modifier and got another denial? What's going on?

Nevada Subscriber

Answer: If your gastroenterologist saw the patient for a condition unrelated to the patient's hospice "condition," then you should use a different modifier.

The definitions of the modifiers follow:
 • GV -- Attending physician not employed or paid under arrangement by the patient's hospice provider (Note: This has nothing to do with whether the physician is seeing the patient for her terminal illness)
 • GW -- Service not related to the hospice patient's terminal illness.

This means if your GI saw the patient for an unrelated reason, you should apply modifier GW instead of modifier GV.

In other words, suppose the patient has an attending physician for his hospice care but requires your gastro-enterologist to address a problem not related to the hospice diagnosis. For instance, the patient is under hospice care due to cancer, so the attending physician is an oncologist. But the patient experiences gastroesophageal reflux disease (GERD) complications and requires a gastroenterologist.

In that case, your gastroenterologist will bill Medicare for his or her services (such as, 99341-99350, Home visit for the evaluation and management of a new or an established patient) with modifier GW appended.

Note: Your place of service will either be 12 (Home) or 34 (Hospice)